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Aryananda RA, Duvekot JJ, Van Beekhuizen HJ, Cininta NI, Ariani G, Dachlan EG. Transabdominal and transvaginal ultrasound findings help to guide the clinical management of placenta accreta spectrum cases. Acta Obstet Gynecol Scand 2024; 103:93-102. [PMID: 37968904 PMCID: PMC10755131 DOI: 10.1111/aogs.14715] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/29/2023] [Accepted: 10/22/2023] [Indexed: 11/17/2023]
Abstract
INTRODUCTION The clinical management of placenta accreta spectrum (PAS) depends on placental topography and vascular involvement. Our aim was to determine whether transabdominal and transvaginal ultrasound signs can predict PAS management. MATERIAL AND METHODS We conducted a retrospective cohort study of consecutive prenatally suspected PAS cases in a single tertiary-care PAS center between January 2021 and July 2022. When PAS was confirmed during surgery, abdominal and transvaginal ultrasound scans were analyzed in relation to PAS management. The preferred surgical approach of PAS was one-step conservative surgery (OSCS). Massive blood loss and PAS topography in the lower bladder trigone necessitated cesarean hysterectomy. Transvaginal ultrasound-diagnosed intracervical hypervascularity was split into three categories based on their quantity. Anatomically, the internal cervical os is located at the level of the bladder trigone and was used as landmark for upper and lower bladder trigone PAS. RESULTS Ninety-one women underwent OSCS and 35 women underwent cesarean hysterectomy (total 126 women with PAS). Abdominal and transvaginal ultrasound features differed significantly between women that underwent OSCS and cesarean hysterectomy: decreased myometrial thickness (<1 mm), 82.4% vs. 100%, p = 0.006; placental bulge, 51.6% vs. 94.3%, p < 0.001; bladder wall interruption, 62.6% vs. 97.1%, p < 0.001; abnormal placental lacunae, 75.8% vs. 100%, p < 0.001; hypervascularity (large lacunae feeding vessels, 57.8% vs. 94.6%, p < 0.001; parametrial hypervascularity, 15.4% vs. 60%, p < 0.001; the rail sign, 6.6% vs. 28.6%, p = 0.003; three-dimensional Doppler intra-placental hypervascularity, 81.3% vs. 100%, p < 0.001; intracervical hypervascularity 60.4% vs. 94.3%, p < 0.001); and cervical length 2.5 ± 0.94 vs. 2.2 ± 0.73, p = 0.038. Other ultrasound signs were not significantly different. The results of multivariable logistic regression showed placental bulge (odds ratio [OR] 9.3; 95% CI 1.9-44.3; p = 0.005), parametrial hypervascularity (OR 4.1; 95% CI 1.541-11.085; p = 0.005), and intracervical hypervascularity (OR 9.2; 95% CI 1.905-44.056; p = 0.006) were weak predictors of OSCS. Intracervical hypervascularity Grade 1 (vascularity <50% of cervical tissue) was more present in OSCS than higher gradings two and three (91% vs. 27.6% vs. 14.3%; p < 0.001). CONCLUSIONS Cesarean hysterectomy is associated with the PAS signs of placental bulge and Grade 2 and 3 intracervical hypervascularity. OSCS is associated with intracervical hypervascularity Grade 1 on transvaginal ultrasound. Prospective validation is required to formulate predictors for PAS management.
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Affiliation(s)
- Rozi Aditya Aryananda
- Department of Obstetrics and Gynecology, Dr. Soetomo Academic General HospitalUniversitas AirlanggaSurabayaIndonesia
- Department of Obstetrics & GynecologyErasmus University Medical CenterRotterdamThe Netherlands
| | - Johannes J. Duvekot
- Department of Obstetrics & GynecologyErasmus University Medical CenterRotterdamThe Netherlands
| | - Heleen J. Van Beekhuizen
- Department of Obstetrics & GynecologyErasmus University Medical CenterRotterdamThe Netherlands
- Department of Gynecological Oncology, Erasmus MC Cancer CenterErasmus University Medical CenterRotterdamThe Netherlands
| | - Nareswari Imanadha Cininta
- Department of Obstetrics and Gynecology, Dr. Soetomo Academic General HospitalUniversitas AirlanggaSurabayaIndonesia
| | - Grace Ariani
- Department of Anatomical Pathology, Dr. Soetomo Academic General HospitalUniversitas AirlanggaSurabayaIndonesia
| | - Erry Gumilar Dachlan
- Department of Obstetrics and Gynecology, Dr. Soetomo Academic General HospitalUniversitas AirlanggaSurabayaIndonesia
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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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Maher GM, Ward LJ, Hernandez L, Kublickas M, Duvekot JJ, McCarthy FP, Khashan AS, Kublickiene K. Association between socioeconomic status with pregnancy and neonatal outcomes: An international multicenter cohort. Acta Obstet Gynecol Scand 2023; 102:1459-1468. [PMID: 37602747 PMCID: PMC10577636 DOI: 10.1111/aogs.14659] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 06/13/2023] [Accepted: 07/20/2023] [Indexed: 08/22/2023]
Abstract
INTRODUCTION Previous evidence examining the association between socioeconomic status and pregnancy complications are conflicted and often limited to using area-based measures of socioeconomic status. In this study, we aimed to examine the association between individual-level socioeconomic factors and a wide range of adverse pregnancy and neonatal outcomes using data from the IMPROvED birth cohort conducted in Sweden, the Netherlands and Republic of Ireland. MATERIAL AND METHODS The study cohort consisted of women who participated in the IMPROvED birth cohort between 2013 and 2017. Data on socioeconomic factors were self-reported and obtained at 15 weeks' gestation, and included level of education, employment status, relationship status, and income. Data on pregnancy and neonatal outcomes included gestational hypertension, pre-eclampsia, gestational diabetes mellitus, emergency cesarean section, preterm birth, post term delivery, small for gestational age and Apgar score at 1 min. These data were obtained within 72 h following delivery and confirmed using medical records. Multivariable logistic regression examined the association between each socioeconomic variable and each outcome separately adjusting for maternal age, maternal body mass index, maternal smoking, maternal alcohol consumption and cohort center. We also examined the effect of exposure to any ≥2 risk factors compared to none. RESULTS A total of 2879 participants were included. Adjusted results suggested that those with less than third level of education had an increased odds of gestational hypertension (OR: 1.74, 95% CI: 1.23-2.46), while those on a middle level of income had a reduced odds of emergency cesarean section (OR: 0.59, 95% CI: 0.42-0.84). No significant associations were observed between socioeconomic variables and neonatal outcomes. Exposure to any ≥2 socioeconomic risk factors was associated with an increased risk of preterm birth (OR: 1.75, 95% CI: 1.06-2.89). CONCLUSIONS We did not find strong evidence of associations between individual-level socioeconomic factors and pregnancy and neonatal outcomes in high-income settings overall, with only few significant associations observed among pregnancy outcomes.
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Affiliation(s)
- Gillian M. Maher
- INFANT Research Centre, University College CorkCorkIreland
- School of Public Health, University College CorkCorkIreland
| | - Liam J. Ward
- Division of Renal MedicineCLINTEC, Karolinska InstitutetStockholmSweden
- Department of Forensic Genetics and Forensic ToxicologyNational Board of Forensic MedicineLinköpingSweden
| | - Leah Hernandez
- Division of Renal MedicineCLINTEC, Karolinska InstitutetStockholmSweden
| | - Marius Kublickas
- Department of Fetal MedicineKarolinska University HospitalStockholmSweden
| | - Johannes J. Duvekot
- Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Erasmus MCUniversity Medical Center RotterdamRotterdamThe Netherlands
| | - Fergus P. McCarthy
- INFANT Research Centre, University College CorkCorkIreland
- Department of Obstetrics and GynecologyUniversity College CorkCorkIreland
| | - Ali S. Khashan
- INFANT Research Centre, University College CorkCorkIreland
- School of Public Health, University College CorkCorkIreland
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Aryananda RA, Nieto-Calvache AJ, Duvekot JJ, Aditiawarman A, Rijken MJ. Management of Unexpected Placenta Accreta Spectrum Cases in Resource-Poor Settings. AJOG Global Reports 2023; 3:100191. [PMID: 37168547 PMCID: PMC10165260 DOI: 10.1016/j.xagr.2023.100191] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023] Open
Abstract
BACKGROUND On a global scale, cases of placenta accreta spectrum are often just identified during cesarean delivery because they are missed during antenatal care screening. Routine operating teams not trained in the management of placenta accreta spectrum are faced with difficult surgical situations and have to make decisions that may define the clinical outcomes. Although there are general recommendations for the intraoperative management of placenta accreta spectrum, no studies have described the clinical reality of unexpected placenta accreta spectrum cases in resource-poor settings. OBJECTIVE This study aimed to describe the maternal outcomes of previously undiagnosed placenta accreta spectrum managed in resource-poor settings in Colombia and Indonesia. STUDY DESIGN This was a retrospective case series of women with histologically confirmed placenta accreta spectrum treated in 2 placenta accreta spectrum centers after referral from remote resource-poor hospitals. Clinical outcomes were analyzed according to the initial type of management: (1) no cesarean delivery; (2) placenta left in situ after cesarean delivery; (3) partial removal of the placenta after cesarean delivery; and (4) post-cesarean hysterectomy. In addition, we evaluated the use of telemedicine by comparing the outcomes of women in hospitals that used the support of the placenta accreta spectrum center during the initial surgery. RESULTS A total of 29 women who were initially managed in Colombia (n=2) and Indonesia (n=27) were included. The lowest volume of blood loss and the lowest frequency of complications were in women who underwent deferred cesarean delivery (n=5; 17.2%) and in those who had a delayed placental delivery (n=5; 20.7%). Five maternal deaths (14%) occurred in the group that did not receive telehelp, and 4 women died of irreversible shock because of uncontrolled bleeding. CONCLUSION Previously undiagnosed placenta accreta spectrum in resource-poor hospitals was associated with a high risk of maternal mortality. Open-close abdominal surgery or leaving the placenta in situ seem to be the best choices for unexpected placenta accreta spectrum management in resource-poor settings. Telemedicine with a placenta accreta spectrum center may improve prognosis.
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van de Meent M, Kleuskens DG, Ganzevoort W, Gordijn SJ, Kooi EMW, Onland W, van Rijn BB, Duvekot JJ, Kornelisse RF, Al-Nasiry S, Jellema RK, Knol HM, Manten GTR, Mulder-de Tollenaer SM, Derks JB, Groenendaal F, Bekker MN, Schuit E, Lely AT, Kooiman J. OPtimal TIming of antenatal COrticosteroid administration in pregnancies complicated by early-onset fetal growth REstriction (OPTICORE): study protocol of a multicentre, retrospective cohort study. BMJ Open 2023; 13:e070729. [PMID: 36931680 PMCID: PMC10030622 DOI: 10.1136/bmjopen-2022-070729] [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] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/19/2023] Open
Abstract
INTRODUCTION Early-onset fetal growth restriction (FGR) requires timely, often preterm, delivery to prevent fetal hypoxia causing stillbirth or neurologic impairment. Antenatal corticosteroids (CCS) administration reduces neonatal morbidity and mortality following preterm birth, most effectively when administered within 1 week preceding delivery. Optimal timing of CCS administration is challenging in early-onset FGR, as the exact onset and course of fetal hypoxia are unpredictable. International guidelines do not provide a directive on this topic. In the Netherlands, two timing strategies are commonly practiced: administration of CCS when the umbilical artery shows (A) a pulsatility index above the 95thh centile and (B) absent or reversed end-diastolic velocity (a more progressed disease state). This study aims to (1) use practice variation to compare CCS timing strategies in early-onset FGR on fetal and neonatal outcomes and (2) develop a dynamic tool to predict the time interval in days until delivery, as a novel timing strategy for antenatal CCS in early-onset FGR. METHODS AND ANALYSIS A multicentre, retrospective cohort study will be performed including pregnancies complicated by early-onset FGR in six tertiary hospitals in the Netherlands in the period between 2012 and 2021 (estimated sample size n=1800). Main exclusion criteria are multiple pregnancies and fetal congenital or genetic abnormalities. Routinely collected data will be extracted from medical charts. Primary outcome for the comparison of the two CCS timing strategies is a composite of perinatal, neonatal and in-hospital mortality. Secondary outcomes include the COSGROVE core outcome set for FGR. A multivariable, mixed-effects model will be used to compare timing strategies on study outcomes. Primary outcome for the dynamic prediction tool is 'days until birth'. ETHICS AND DISSEMINATION The need for ethical approval was waived by the Ethics Committee (University Medical Center Utrecht). Results will be published in open-access, peer-reviewed journals and disseminated by presentations at scientific conferences. TRIAL REGISTRATION NUMBER ClinicalTrials.gov: NCT05606497.
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Affiliation(s)
- Mette van de Meent
- Department of Obstetrics and Gynaecology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Dianne G Kleuskens
- Department of Obstetrics and Gynaecology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Wessel Ganzevoort
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Center, location AMC, Amsterdam, Netherlands
| | - Sanne J Gordijn
- Department of Obstetrics and Gynaecology, University Medical Center Groningen, Groningen, Netherlands
| | - Elisabeth M W Kooi
- Department of Pediatrics, University Medical Center Groningen, Groningen, Netherlands
| | - Wes Onland
- Department of Pediatrics, Amsterdam University Medical Center, location AMC, Amsterdam, Netherlands
- Amsterdam Reproduction and Development, Amsterdam, Netherlands
| | - Bas B van Rijn
- Department of Obstetrics and Gynaecology, Erasmus MC, Rotterdam, Netherlands
| | - Johannes J Duvekot
- Department of Obstetrics and Gynaecology, Erasmus MC, Rotterdam, Netherlands
| | | | - Salwan Al-Nasiry
- Department of Obstetrics and Gynaecology, Maastricht UMC+, Maastricht, Netherlands
| | - Reint K Jellema
- Department of Pediatrics, Maastricht UMC+, Maastricht, Netherlands
| | - H Marieke Knol
- Department of Obstetrics and Gynaecology, Isala Zwolle, Zwolle, Netherlands
| | | | | | - Jan B Derks
- Department of Obstetrics and Gynaecology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Floris Groenendaal
- Department of Neonatology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Mireille N Bekker
- Department of Obstetrics and Gynaecology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Ewoud Schuit
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - A Titia Lely
- Department of Obstetrics and Gynaecology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Judith Kooiman
- Department of Obstetrics and Gynaecology, University Medical Center Utrecht, Utrecht, Netherlands
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Tong WH, Hop WCJ, Duvekot JJ. Are troponin T levels in women with pre-eclampsia related to development of pulmonary oedema? Eur J Obstet Gynecol Reprod Biol 2023; 282:168-169. [PMID: 36682957 DOI: 10.1016/j.ejogrb.2023.01.007] [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: 09/30/2022] [Accepted: 01/05/2023] [Indexed: 01/09/2023]
Affiliation(s)
- Wing H Tong
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - Wim C J Hop
- Department of Biostatistics, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - Johannes J Duvekot
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, University Medical Center Rotterdam, The Netherlands.
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Kókai LL, van der Bijl MF, Hagger MS, Ceallaigh DTÓ, Rohde KIM, van Kippersluis H, Burdorf A, Duvekot JJ, van Lennep JER, Wijtzes AI. Correction: Needs and preferences of women with prior severe preeclampsia regarding app-based cardiovascular health promotion. BMC Womens Health 2023; 23:9. [PMID: 36624420 PMCID: PMC9830752 DOI: 10.1186/s12905-022-02133-x] [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] [Accepted: 12/16/2022] [Indexed: 01/11/2023] Open
Affiliation(s)
- Lili L. Kókai
- grid.5645.2000000040459992XDepartment of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands ,P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Marte F. van der Bijl
- grid.5645.2000000040459992XDepartment of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Martin S. Hagger
- grid.266096.d0000 0001 0049 1282Department of Psychological Sciences, University of California, Merced, CA USA ,grid.9681.60000 0001 1013 7965Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Diarmaid T. Ó. Ceallaigh
- grid.6906.90000000092621349Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, The Netherlands ,grid.6906.90000000092621349Tinbergen Institute, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Kirsten I. M. Rohde
- grid.6906.90000000092621349Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, The Netherlands ,grid.6906.90000000092621349Tinbergen Institute and Erasmus Research Institute of Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Hans van Kippersluis
- grid.6906.90000000092621349Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, The Netherlands ,grid.6906.90000000092621349Tinbergen Institute, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Alex Burdorf
- grid.5645.2000000040459992XDepartment of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Johannes J. Duvekot
- grid.5645.2000000040459992XDepartment of Obstetrics and Gynecology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Jeanine E. Roeters van Lennep
- grid.5645.2000000040459992XDepartment of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Anne I. Wijtzes
- grid.5645.2000000040459992XDepartment of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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Maggen C, Wolters VERA, Van Calsteren K, Cardonick E, Laenen A, Heimovaara JH, Mhallem Gziri M, Fruscio R, Duvekot JJ, Painter RC, Masturzo B, Shmakov RG, Halaska M, Berveiller P, Verheecke M, de Haan J, Gordijn SJ, Amant F. Impact of chemotherapy during pregnancy on fetal growth. J Matern Fetal Neonatal Med 2022; 35:10314-10323. [PMID: 36202393 DOI: 10.1080/14767058.2022.2128645] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Chemotherapy crosses the placenta, however, it remains unclear to what extent it affects fetal growth. The current literature suggests up to 21% of the offspring of women receiving chemotherapy are small for gestational age (SGA, birth weight <10th percentile). Limiting research to birth weights only might misjudge fetal growth restriction (FGR) in this high-risk population with multiple risk factors for impaired fetal growth. Moreover, the role of the duration of chemotherapy and gestational age at initiation of chemotherapy in fetal growth is yet poorly understood. OBJECTIVE This retrospective cohort study evaluates fetal growth and neonatal birthweights in pregnant women receiving chemotherapy. STUDY DESIGN All pregnant patients, registered by the International Network of Cancer, Infertility and Pregnancy (INCIP), treated with chemotherapy with at least two ultrasounds reporting on fetal growth, were eligible for this study. Duration and gestational age at initiation of chemotherapy were our major determinants, followed by cancer type and stage, maternal characteristics (parity, BMI, ethnicity hypertension, and diabetes) and individual cytotoxic agents (anthracycline, taxanes, and platinum). Fetal growth outcomes were described using the following mutually exclusive groups (1) FGR, based on a Delphi consensus (2016); (2) "low risk SGA" (birth weight below the 10th percentile), but an estimated growth above the 10th percentile; (3) "fetal growth disturbance", which did not meet all FGR criteria; (4) "non-FGR". Obstetric and oncological characteristics were compared between the growth impaired groups and non-FGR group. We calculated estimated fetal weight (EFW) according to Hadlock's formula (1991) and birth weight percentile according to Nicolaides (2018). We used univariable and multivariable regression, and linear mixed effect models to investigate the effect of duration and gestational age at initiation of chemotherapy on birth weight, and fetal growth, respectively. RESULTS We included 201 patients, diagnosed with cancer between March 2000 and March 2020. Most patients were diagnosed with breast cancer (n = 132, 66%). Regimens included anthracyclines (n = 121, 60%), (anthracyclines and) taxanes (n = 45, 22%) and platinum (n = 35, 17%). Fetal growth abnormalities were detected in 75 pregnancies: 43 (21%) FGR, 10 (5%) low risk SGA and 22 (8.5%) fetal growth disturbance. Chemotherapy prior to 20 weeks of gestation (47% vs. 25%, p = .04) and poor maternal gestational weight gain (median percentile 15 (range 0-97) vs. 8 (0-84), p = .03) were more frequent in the FGR group compared to the non-FGR group, whereas no difference was seen for specific chemotherapy or cancer types. Univariable regression identified gestational weight gain, hypertension, systemic disease, parity, neonatal sex and maternal BMI as confounders for birth weight percentiles. Multivariable regression revealed that each additional week of chemotherapy was associated with lower birth weight percentiles (-1.06; 95%CI -2.01; -0.04; p = .04), and that later initiation of chemotherapy was associated with an increase in birth weight percentile (1.10 per week; 95%CI 0.26; 1.95; p = .01). Each additional week of chemotherapy was associated with lower EFW and abdominal circumference (AC) percentiles (-1.77; 95%CI -2.21; -1.34, p < .001; -1.64; 95%CI -1.96; -1.32, p < .001, respectively). CONCLUSIONS This study demonstrates that FGR is common after chemotherapy in pregnancy, and that the duration of chemotherapy has a negative impact. Sonographic follow-up of fetal growth and well-being is recommended.
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Affiliation(s)
- Charlotte Maggen
- Department of Oncology, KU Leuven, Leuven, Belgium.,Department of Obstetrics and Prenatal Medicine, University Hospital Brussels, Brussels, Belgium
| | - Vera E R A Wolters
- Department of Gynecology, Antoni van Leeuwenhoek - Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Kristel Van Calsteren
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium.,Department of Development and regeneration, KU Leuven, Leuven, Belgium
| | - Elyce Cardonick
- Department of Obstetrics and Gynecology, Cooper, University Health Care, Camden, NJ, USA
| | | | | | - Mina Mhallem Gziri
- Department of Obstetrics, Cliniques Universitaires St Luc, UCL, Sint-Lambrechts-Woluwe, Belgium
| | - Robert Fruscio
- Clinic of Obstetrics and Gynecology, University of Milan - Bicocca, San Gerardo Hospital, Monza, Italy
| | - Johannes J Duvekot
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Rebecca C Painter
- Department of Obstetrics and Gynecology, Reproduction and Development, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Bianca Masturzo
- Department Surgical Sciences, University of Torino, Torino, Italy
| | - Roman G Shmakov
- National Medical Research Centre for Obstetrics, Gynecology and Perinatology Named After Academician V.I. Kulakov of the Ministry of Healthcare of Russian Federation, Moscow, Russia
| | - Michael Halaska
- Faculty Hospital Kralovske, Vinohrady and 3rd Medical Faculty, Charles University, Prague, Czech Republic
| | - Paul Berveiller
- Department of Obstetrics and Gynecology, Centre Hospitalier Intercommunal de Poissy Saint Germain, Poissy, Université Paris Saclay, Gif-sur-Yvette, France
| | - Magali Verheecke
- Department of Obstetrics and Gynecology, General Hospital, Turnhout, Belgium
| | - Jorine de Haan
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Sanne J Gordijn
- Department of Obstetrics and Gynecology, University Medical Center Groningen, Groningen, The Netherlands
| | - Frédéric Amant
- Department of Oncology, KU Leuven, Leuven, Belgium.,Department of Gynecology, Antoni van Leeuwenhoek - Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Obstetrics & Gynecology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
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9
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Nij Bijvank SW, Hengst M, Cornette JC, Huigen S, Winkelen AV, Edens MA, Duvekot JJ. Nicardipine for treating severe antepartum hypertension during pregnancy: Nine years of experience in more than 800 women. Acta Obstet Gynecol Scand 2022; 101:1017-1025. [PMID: 35707886 DOI: 10.1111/aogs.14406] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 04/20/2022] [Accepted: 05/18/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Women with severe hypertension during pregnancy require prompt stabilization with a combination of magnesium sulfate and rapidly acting intravenously administered antihypertensives. It remains unknown which antihypertensive is best suited for pregnancy. The present study evaluated the intravenous use of the calcium antagonist, nicardipine. MATERIAL AND METHODS This multicenter, retrospective case series included all pregnant women beyond 20 weeks of gestation with severe antepartum hypertension that were treated with intravenous nicardipine. PRIMARY OUTCOME MEASURES successful treatment, time to successful treatment, and maternal safety. Severe hypertension was defined as systolic blood pressure (SBP) of 160 mm Hg or more and/or diastolic blood pressure (DBP) of 110 mm Hg or more. RESULTS This study included 830 women. After 1 h of treatment, two-thirds of the women had SBP below 160 mm Hg and DBP below 100 mm Hg. In three out of four women, the mean arterial pressure was below 120 mm Hg. Within 2 h of treatment, 77.4% of women achieved successful treatment. In all cases, nicardipine was eventually effective. Within the first 2 h, 42.7% of women experienced temporary low DBP (ie below 70 mm Hg) without clinical consequences for the mother or fetus. In all cases, the low DBP resolved after discontinuing or reducing the dosage of nicardipine. One case of fetal distress was attributable to maternal hypotension, and a cesarean section was performed at more than 2 h after initiating therapy. During treatment, headache, nausea, and vomiting decreased significantly. CONCLUSIONS To date, this was the largest case-series study on the use of nicardipine for treating severe antepartum hypertension in pregnancy. We found that nicardipine could effectively and safely treat this condition. Based on its high success rate and acceptable safety profile, nicardipine should be considered a first-line treatment in women with severe hypertension in pregnancy.
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Affiliation(s)
- Sebastiaan W Nij Bijvank
- Department of Obstetrics and Gynecology, Isala Women's and Children's Hospital, Zwolle, The Netherlands
| | - Micky Hengst
- Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jerome C Cornette
- Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Sigrid Huigen
- Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Anne van Winkelen
- Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Mireille A Edens
- Department of Clinical Epidemiology, Isala Women's and Children's Hospital, Zwolle, The Netherlands
| | - Johannes J Duvekot
- Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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10
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Hendriks B, van Uitert E, Schoenmakers S, Duvekot JJ, Gommers D, Cornette JMJ, van de Sande D, van Bommel J, van Kampen JJA, Cornette J. Gravid uterine torsion after prone positioning in SARS-CoV2 (COVID-19)-related acute respiratory distress syndrome. J Surg Case Rep 2022; 2022:rjac289. [PMID: 35769307 PMCID: PMC9230700 DOI: 10.1093/jscr/rjac289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 05/27/2022] [Indexed: 11/14/2022] Open
Abstract
Abstract
A multiparous pregnant patient was admitted to the intensive care unit in her third trimester of pregnancy for prone positioning mechanical ventilation after developing SARS-CoV2 (COVID-19)-related acute respiratory distress syndrome. Repositioning in left lateral tilt was followed by uterine contractions and cardiotocography alterations. Preterm caesarean section was performed based on persistent foetal tachycardia and suspected foetal distress, followed by a per-operative diagnosis of uterine levotorsion. This case report is the first to explore a potential causal link between prolonged prone positioning in late pregnancy and postural gravid uterine torsion and highlights the need for appropriate foetal monitoring during prone positioning mechanical ventilation support.
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Affiliation(s)
- Bavo Hendriks
- Department of Uro-Gynaecology, Ghent University Hospital (Universitair Ziekenhuis Gent) , Corneel Heymanslaan 10, B-9000 Ghent , Belgium
- Department of Obstetrics and Gynaecology, Erasmus MC University Medical Center , Wytemaweg 80, 3015 CN Rotterdam , The Netherlands
| | - Evelyne van Uitert
- Department of Obstetrics and Gynaecology, Erasmus MC University Medical Center , Wytemaweg 80, 3015 CN Rotterdam , The Netherlands
| | - Sam Schoenmakers
- Department of Obstetrics and Gynaecology, Erasmus MC University Medical Center , Wytemaweg 80, 3015 CN Rotterdam , The Netherlands
| | - Johannes J Duvekot
- Department of Obstetrics and Gynaecology, Erasmus MC University Medical Center , Wytemaweg 80, 3015 CN Rotterdam , The Netherlands
| | - Diederik Gommers
- Department of Adult Intensive Care, Erasmus MC University Medical Center , Room Ne-413, Doctor Molewaterplein 40, 3015 GD Rotterdam , The Netherlands
| | - Jérôme M J Cornette
- Department of Obstetrics and Gynaecology, Erasmus MC University Medical Center , Wytemaweg 80, 3015 CN Rotterdam , The Netherlands
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11
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Tahitu M, Ramler PI, Gillissen A, Caram-Deelder C, Henriquez DDCA, de Maat MPM, Duvekot JJ, Eikenboom J, Bloemenkamp KWM, van den Akker T, van der Bom JG. Clinical value of early assessment of hyperfibrinolysis by rotational thromboelastometry during postpartum hemorrhage for the prediction of severity of bleeding: A multicenter prospective cohort study in the Netherlands. Acta Obstet Gynecol Scand 2021; 101:145-152. [PMID: 34729767 DOI: 10.1111/aogs.14279] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 07/04/2021] [Accepted: 09/16/2021] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Coagulopathy may be the result of hyperfibrinolysis and could exacerbate bleeding following childbirth. Timely recognition of hyperfibrinolysis during the earliest stages of postpartum hemorrhage could identify women at risk of more severe blood loss who may benefit from targeted anti-fibrinolytic therapy. Rotational thromboelastometry (ROTEM® ) is a point-of-care test that could detect hyperfibrinolysis. The aim of this study was to evaluate whether early assessment of hyperfibrinolysis by ROTEM during postpartum hemorrhage could predict progression to severe postpartum hemorrhage. MATERIAL AND METHODS During a prospective cohort study in the Netherlands among women with postpartum hemorrhage (total blood loss at least 1000 ml within 24 h after childbirth) ROTEM measurements were performed following 800-1500 ml of blood loss. Hyperfibrinolysis was defined as an enzymatic fibrinolysis index (ROTEM EXTEM maximum clot lysis [ML] minus the ROTEM APTEM ML) above 15%. Severe postpartum hemorrhage was defined as a composite end point of total blood loss greater than 2000 ml, transfusion of four or more units of packed cells, and/or need for an invasive intervention. The predictive value of hyperfibrinolysis for progression to severe postpartum hemorrhage was assessed by area under the receiver operating curve (AUC) and positive and negative predictive values. TRIAL REGISTRATION ClinicalTrials.gov (NCT02149472). RESULTS Of 390 women included, 82 (21%) had severe postpartum hemorrhage. Four (1%) women had thromboelastometric evidence of hyperfibrinolysis, of whom two developed severe postpartum hemorrhage. The AUC for enzymatic fibrinolysis index more than 15% for progression to severe postpartum hemorrhage was 0.47 (95% CI 0.40-0.54). Positive and negative predictive values for this index were 50.0% (95% CI 6.8-93.2) and 79.3% (95% CI 74.9-83.2), respectively. CONCLUSIONS Thromboelastometric evidence of hyperfibrinolysis was rare in women with postpartum hemorrhage when assessed between 800 and 1500 ml of blood loss. The clinical predictive value of viscoelastometric point-of-care testing for hyperfibrinolysis for progression to severe postpartum hemorrhage during early postpartum hemorrhage is limited.
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Affiliation(s)
- Marije Tahitu
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands.,Department of Obstetrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Paul I Ramler
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands.,Department of Obstetrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Ada Gillissen
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands.,Department of Obstetrics, Leiden University Medical Center, Leiden, the Netherlands.,Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, 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
| | - 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.,Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Moniek P M de Maat
- Department of Hematology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Johannes J Duvekot
- Department of Obstetrics, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Jeroen Eikenboom
- Division of Thrombosis and Hemostasis, Department of Internal Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Kitty W M Bloemenkamp
- Division Woman and Baby, Department of Obstetrics, Birth Center Wilhelmina Children Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Thomas van den Akker
- Department of Obstetrics, Leiden University Medical Center, Leiden, the Netherlands.,Faculty of Science, VU University Medical Center, Athena Institute, Amsterdam, the Netherlands.,National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| | - 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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12
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Wiegers H, Hamulyák EN, Damhuis SE, van Duuren JR, Darwish Murad S, Scheres L, Gordijn SJ, Leentjens J, Duvekot JJ, Lauw MN, Hutten BA, Middeldorp S, Ganzevoort W. Pregnancy outcomes in women with Budd-Chiari syndrome or portal vein thrombosis - a multicentre retrospective cohort study. BJOG 2021; 129:608-617. [PMID: 34520620 PMCID: PMC9293458 DOI: 10.1111/1471-0528.16915] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 08/25/2021] [Accepted: 08/29/2021] [Indexed: 11/29/2022]
Abstract
Objective To evaluate current practice and outcomes of pregnancy in women previously diagnosed with Budd–Chiari syndrome and/or portal vein thrombosis, with and without concomitant portal hypertension. Design and setting Multicentre retrospective cohort study between 2008 and 2021. Population Women who conceived in the predefined period after the diagnosis of Budd–Chiari syndrome and/or portal vein thrombosis. Methods and main outcome measures We collected data on diagnosis and clinical features. The primary outcomes were maternal mortality and live birth rate. Secondary outcomes included maternal, neonatal and obstetric complications. Results Forty‐five women (12 Budd–Chiari syndrome, 33 portal vein thrombosis; 76 pregnancies) were included. Underlying prothrombotic disorders were present in 23 of the 45 women (51%). Thirty‐eight women (84%) received low‐molecular‐weight heparin during pregnancy. Of 45 first pregnancies, 11 (24%) ended in pregnancy loss and 34 (76%) resulted in live birth of which 27 were at term (79% of live births and 60% of pregnancies). No maternal deaths were observed; one woman developed pulmonary embolism during pregnancy and two women (4%) had variceal bleeding requiring intervention. Conclusions The high number of term live births (79%) and lower than expected risk of pregnancy‐related maternal and neonatal morbidity in our cohort suggest that Budd–Chiari syndrome and/or portal vein thrombosis should not be considered as an absolute contraindication for pregnancy. Individualised, nuanced counselling and a multidisciplinary pregnancy surveillance approach are essential in this patient population. Tweetable abstract Budd–Chiari syndrome and/or portal vein thrombosis should not be considered as an absolute contraindication for pregnancy. Budd–Chiari syndrome and/or portal vein thrombosis should not be considered as an absolute contraindication for pregnancy. Linked article This article is commented on by YY Chung & MA Heneghan pp. 618 in this issue. To view this minicommentary visit https://doi.org/10.1111/1471-0528.17002.
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Affiliation(s)
- Hmg Wiegers
- Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - E N Hamulyák
- Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - S E Damhuis
- Department of Obstetrics and Gynaecology, Amsterdam UMC, University of Amsterdam, Amsterdam Reproduction & Development Research Institute, Amsterdam, The Netherlands.,Department of Obstetrics and Gynaecology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - J R van Duuren
- Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands.,Department of Obstetrics and Gynaecology, Amsterdam UMC, University of Amsterdam, Amsterdam Reproduction & Development Research Institute, Amsterdam, The Netherlands
| | - S Darwish Murad
- Department of Gastroenterology and Hepatology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Ljj Scheres
- Department of Internal Medicine &, Radboud Institute of Health Sciences (RIHS), Radboud University Medical Centre, Nijmegen, The Netherlands
| | - S J Gordijn
- Department of Obstetrics and Gynaecology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - J Leentjens
- Department of Internal Medicine &, Radboud Institute of Health Sciences (RIHS), Radboud University Medical Centre, Nijmegen, The Netherlands
| | - J J Duvekot
- Department of Obstetrics and Gynaecology, Erasmus University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - M N Lauw
- Deparment of Haematology, Erasmus University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - B A Hutten
- Departmentof Epidemiology and Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - S Middeldorp
- Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands.,Department of Internal Medicine &, Radboud Institute of Health Sciences (RIHS), Radboud University Medical Centre, Nijmegen, The Netherlands
| | - W Ganzevoort
- Department of Obstetrics and Gynaecology, Amsterdam UMC, University of Amsterdam, Amsterdam Reproduction & Development Research Institute, Amsterdam, The Netherlands
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13
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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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14
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Nunes I, Dupont C, Timonen S, Ayres de Campos D, Cole V, Schwarz C, Kwee A, Yli B, Vayssiere C, Roth GE, Gliozheni E, Savochkina Y, Ivanisevic M, Janku P, Timonen S, Daskalakis G, Beke A, Santo S, Druškovič M, Duvekot JJ, Farr A, Dreyfus M. European Guidelines on Perinatal Care - Oxytocin for induction and augmentation of labor[Formula: see text]. J Matern Fetal Neonatal Med 2021; 35:7166-7172. [PMID: 34470113 DOI: 10.1080/14767058.2021.1945577] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OF RECOMMENDATIONS1. Oxytocin for induction or augmentation of labor should not be started when there is a previous scar on the body of the uterus (such as previous classical cesarean section, uterine perforation or myomectomy when uterine cavity is reached) or in any other condition where labor or vaginal delivery are contraindicated. (Moderate quality evidence +++-; Strong recommendation).2. Oxytocin should not be started before at least 1 h has elapsed since amniotomy, 6 h since the use of dinoprostone (30 min if vaginal insert) and 4 h since the use of misoprostol (Low quality evidence ++- -; Moderate recommendation).3. Cardiotocography (CTG) should be performed and a normal pattern without tachysystole should be documented for at least 30 min before oxytocin is used. Continuous CTG, with adequate monitoring of both fetal heart rate and uterine contractions, should be maintained for as long as oxytocin is used, and thereafter until delivery (Low ++- - to moderate +++- quality evidence; Strong recommendation).4. For labor induction, at least 1-h should be allowed after amniotomy before oxytocin infusion is started, to evaluate whether adequate uterine contractility has meanwhile ensued. For augmentation of labor, if the membranes are intact and there are conditions for a safe amniotomy, the latter should be considered before oxytocin is started (Very low quality evidence +- --; Weak recommendation).5. Oxytocin should be administered intravenously using the following regimen: 5 IU oxytocin diluted in 500 mL of 0.9% normal saline (NaCl) (each mL contains 10 mIU of oxytocin), in an infusion pump at increasing rates, as shown in Table 1, until a frequency of 3-4 contractions per 10 min is reached, a non-reassuring CTG pattern ensues, or maximum rates are reached (Low quality evidence ++ - -; Strong recommendation). If the frequency of contractions exceeds 5 in 10 min, the infusion rate should be reduced, even if a normal CTG pattern is present. With a non-reassuring CTG pattern, urgent clinical assessment by an obstetrician is indicated, and strong consideration should be given to reducing or stopping the oxytocin infusion. The minimal effective dose of oxytocin should always be used. (Low ++- - to Moderate +++- - quality evidence; Strong recommendation).[Table: see text]6. Use of oxytocin for induction and augmentation of labor should be regularly audited (Low quality evidence ++--; Strong recommendation).
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Affiliation(s)
| | - Inês Nunes
- School of Medicine and Biomedical Sciences (ICBAS), University Hospital Center of Porto, CINTESIS - Center for Health Technology and Services Research, University of Porto, Porto, Portugal
| | - Corinne Dupont
- University Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE) INSERM U1290; AURORE Perinatal Network, Hospices Civils de Lyon, Croix-Rousse Hospital, Lyon, France
| | - Susanna Timonen
- Finnish Society of Perinatology, Turku University Hospital, Turku University, Turku, Finland
| | | | | | | | - Christiane Schwarz
- Dept. Midwifery Science, University Lubeck, Institute for Health Sciences, Lubeck, Germany
| | - Anneke Kwee
- Department of Obstetrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Branka Yli
- Delivery Deparment, Oslo University Hospital, Oslo, Norway
| | - Christophe Vayssiere
- Department of Obstetrics and Gynecology, Paule de Viguier Hospital, CHU Toulouse; UMR1295 CERPOP (Centre for Epidemiology and Population Health Research), Team SPHERE (Study of Perinatal, Paedriatric and Adolescent Health: Epidemiological Research and Evaluation) Toulouse III University, Toulouse, France
| | | | - Elko Gliozheni
- Albanian Association of Perinatology, Department of Obstetrics and Gynecology, University Hospital of Obstetrics and Gynaecology 'Koco Gliozheni', Tirana, Albania
| | - Yuliya Savochkina
- Bielorussian Society of Human Reproduction, 5th Minsk City Hospital and Belarus Medical Academy of Postgraduate Education, Minsk, Belarus
| | - Marina Ivanisevic
- Croatian Association of Perinatal Medicine, University Clinic for Obstetrics and Gynecology, School of Medicine, Zagreb, Croatia
| | - Petr Janku
- Czech Society of Perinatology and Feto-Maternal Medicine, Department of Obstetrics and Gynecology, University Hospital Brno, Masaryk University Brno, Brno, Czech Republic; Department of Nursing and Midwifery, Masaryk University Brno, Czech Republic
| | - Susanna Timonen
- Finnish Society of Perinatology, Turku University Hospital, Turku University, Turku, Finland
| | - George Daskalakis
- Hellenic Society of Perinatal Medicine, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Artur Beke
- Hungarian Society of Perinatology and Obstetric Anesthesiology, Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary
| | - Susana Santo
- Portuguese Society of Obstetrics and Maternal-Fetal Medicine, Santa Maria Hospital, University of Lisbon Medical School, Lisbon, Portugal
| | - Mirjam Druškovič
- Slovenia Medical Association - Society of Perinatal Medicine, Division of Obstetrics and Gynecology, UMC Ljubljana, Ljubljana, Slovenia
| | - J J Duvekot
- Dutch Society of Obstetrics and Gynecology, Department of Obstetrics, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Alex Farr
- Austrian Society for Pre- and Perinatal Medicine, Department of Obstetrics and Gynecology, Division of Obstetrics and feto-maternal Medicine, Medical University of Vienna, Vienna, Austria
| | - Michel Dreyfus
- Societé Française de Medicine Perinatale, Service d'Obstétrique, Gynécologie et Médecine de la Reproduction, Centre Hospitalier Universitaire de Caen, Caen, France
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15
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Ramlakhan KP, Gommers D, Jacobs CERM, Makouri K, Duvekot JJ, Reiss IKM, Franx A, Roos-Hesselink JW, Cornette JMJ. Women of reproductive age in a tertiary intensive care unit: indications, outcome and the impact of pregnancy-a retrospective cohort study. BMC Womens Health 2021; 21:248. [PMID: 34147093 PMCID: PMC8214372 DOI: 10.1186/s12905-021-01396-0] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 05/31/2021] [Indexed: 08/26/2023]
Abstract
Background To evaluate the indications for admission and mortality rates of women of reproductive age admitted to a tertiary Intensive Care Unit (ICU) and to compare the outcomes of obstetric and non-obstetric admissions.
Methods
A retrospective cohort study was performed, including all women aged 17–41 years admitted to a level 3 ICU in the Netherlands, between January 1, 2000 and January 1, 2016. Primary outcome was indication for admission and mortality. Mortality, length of stay (LOS), need for mechanical ventilation and APACHE II score were compared between obstetric and non-obstetric admissions. The obstetric group was further analyzed for maternal and perinatal outcomes. Results 3461 women (median age 32 years) were included, with an overall mortality rate of 13.3%. The obstetric group consisted of 265 women (7.7%). The non-obstetric group (n = 3196) was admitted most often for cardiovascular disease (19.6%), followed by oncologic disease (15%). Mortality was the highest in women with oncologic disease (23.9%). The obstetric group had lower mortality compared to the non-obstetric group (4.9% vs. 14%, p < 0.001), despite higher APACHE II score (14 vs. 11, p < 0.001) and a higher ventilation rate (47.9% vs. 39%, p = 0.004). Major surgical or endovascular interventions, besides caesarean section, were performed in 46% of the obstetric group. Perinatal death occurred in 17.2% and of the surviving infants, 63.2% were born preterm and 45.1% required Neonatal Intensive Care Unit admission. Conclusions Cardiovascular disease is the most important indication for admission and oncologic disease is associated with highest mortality in women of reproductive age. Obstetric patients constitute a small percentage of all ICU admissions in a tertiary ICU center. They have lower mortality rates than non-obstetric young female patients, despite a more severe initial presentation. Nevertheless lasting maternal morbidity and perinatal mortality and morbidity is frequent.
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Affiliation(s)
- Karishma P Ramlakhan
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
| | - Diederik Gommers
- Department of Adult Intensive Care Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Carmen E R M Jacobs
- Department of Obstetrics and Gynecology, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Khaoula Makouri
- Department of Obstetrics and Gynecology, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Johannes J Duvekot
- Department of Obstetrics and Gynecology, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Irwin K M Reiss
- Division of Neonatology, Department of Pediatrics, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Arie Franx
- Department of Obstetrics and Gynecology, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jolien W Roos-Hesselink
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Jérôme M J Cornette
- Department of Obstetrics and Gynecology, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
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16
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van Beekhuizen HJ, Stefanovic V, Schwickert A, Henrich W, Fox KA, MHallem Gziri M, Sentilhes L, Gronbeck L, Chantraine F, Morel O, Bertholdt C, Braun T, Rijken MJ, Duvekot JJ. A multicenter observational survey of management strategies in 442 pregnancies with suspected placenta accreta spectrum. Acta Obstet Gynecol Scand 2021; 100 Suppl 1:12-20. [PMID: 33483943 PMCID: PMC8048500 DOI: 10.1111/aogs.14096] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [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: 10/16/2020] [Revised: 12/21/2020] [Accepted: 01/18/2021] [Indexed: 11/29/2022]
Abstract
Introduction Management options for women with placenta accreta spectrum (PAS) comprise termination of pregnancy before the viable gestational age, leaving the placenta in situ for subsequent reabsorption of the placenta or delayed hysterectomy, manual removal of placenta after vaginal delivery or during cesarean section, focal resection of the affected uterine wall, and peripartum hysterectomy. The aim of this observational study was to describe actual clinical management and outcomes in PAS in a large international cohort. Material and methods Data from women in 15 referral centers of the International Society of PAS (IS‐PAS) were analyzed and correlated with the clinical classification of the IS‐PAS: From Grade 1 (no PAS) to Grade 6 (invasion into pelvic organs other than the bladder). PAS was usually diagnosed antenatally and the operators performing ultrasound rated the likelihood of PAS on a Likert scale of 1 to 10. Results In total, 442 women were registered in the database. No maternal deaths occurred. Mean blood loss was 2600 mL (range 150‐20 000 mL). Placenta previa was present in 375 (84.8%) women and there was a history of a previous cesarean in 329 (74.4%) women. The PAS likelihood score was strongly correlated with the PAS grade (P < .001). The mode of delivery in the majority of women (n = 252, 57.0%) was cesarean hysterectomy, with a repeat laparotomy in 20 (7.9%) due to complications. In 48 women (10.8%), the placenta was intentionally left in situ, of those, 20 (41.7%) had a delayed hysterectomy. In 26 women (5.9%), focal resection was performed. Termination of pregnancy was performed in 9 (2.0%), of whom 5 had fetal abnormalities. The placenta could be removed in 90 women (20.4%) at cesarean, and in 17 (3.9%) after vaginal delivery indicating mild or no PAS. In 34 women (7.7%) with an antenatal diagnosis of PAS, the placenta spontaneously separated (false positives). We found lower blood loss (P < .002) in 2018‐2019 compared with 2009‐2017, suggesting a positive learning curve. Conclusions In referral centers, the most common management for severe PAS was cesarean hysterectomy, followed by leaving the placenta in situ and focal resection. Prenatal diagnosis correlated with clinical PAS grade. No maternal deaths occurred.
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Affiliation(s)
- Heleen J van Beekhuizen
- Department of Gynecological Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Vedran Stefanovic
- Department of Obstetrics and Gynecology, Fetomaternal Medical Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Alexander Schwickert
- Department of Obstetrics and Department of Experimental Obstetrics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Wolfgang Henrich
- Department of Obstetrics and Department of Experimental Obstetrics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Karin A Fox
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA
| | - Mina MHallem Gziri
- Department of Obstetrics, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Loïc Sentilhes
- Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux, France
| | - Lene Gronbeck
- Department of Obstetrics, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Frederic Chantraine
- Department of Obstetrics and Gynecology, Centre Hospitalier Universitaire de Liège, Site CHR Citadelle, Liège, Belgium
| | - Oliver Morel
- Nancy Regional and University Hospital Center (CHRU, Women's Division, Université de Lorraine, Nancy, France.,Diagnosis and International Adaptive Imaging (IADI) Unit, Inserm, Université de Lorraine, Nancy, France
| | - Charline Bertholdt
- Nancy Regional and University Hospital Center (CHRU, Women's Division, Université de Lorraine, Nancy, France.,Diagnosis and International Adaptive Imaging (IADI) Unit, Inserm, Université de Lorraine, Nancy, France
| | - Thorsten Braun
- Department of Obstetrics and Department of Experimental Obstetrics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Marcus J Rijken
- Department of Obstetrics, Division Women and Baby, Julius Global Health, The Julius center for Health Sciences and Primary Care, University Medical center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Johannes J Duvekot
- Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, University Medical center Rotterdam, Rotterdam, the Netherlands
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17
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Gairabekova D, van Rosmalen J, Duvekot JJ. Outcome of early-onset fetal growth restriction with or without abnormal umbilical artery Doppler flow. Acta Obstet Gynecol Scand 2021; 100:1430-1438. [PMID: 33690882 PMCID: PMC8360092 DOI: 10.1111/aogs.14142] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 03/04/2021] [Accepted: 03/05/2021] [Indexed: 11/28/2022]
Abstract
Introduction Early‐onset fetal growth restriction is a pregnancy complication often coinciding with abnormal Doppler flow in the umbilical artery. Absent or reversed end‐diastolic flow in the umbilical artery is associated with adverse perinatal outcome. As the optimal management of this condition is unclear, the objective of this study was to analyze the time interval from admission to delivery of pregnancies with early‐onset fetal growth restriction, while pursuing a policy of postponing delivery unless active management of labor would be required because of fetal distress or maternal condition. We also assessed short‐ and long‐term perinatal outcome. Material and methods In this historical cohort study, all pregnant women with singleton pregnancies, admitted during 2004–2015 with early‐onset fetal growth restriction were included. Pregnancies with absent or reversed end‐diastolic flow (AREDF) were compared with pregnancies with a positive end‐diastolic Doppler flow (PEDF). Time until delivery was determined and perinatal outcome was assessed for both groups. Results In our study, 111 women were allocated to the PEDF group and 109 to the AREDF group. In the AREDF group, fetal distress was more often an indication for delivery, in comparison with the PEDF group (p = .004). Median time until delivery in patients admitted between 26 and 28 weeks’ gestation was 6+5 weeks in the PEDF group and 1+4 weeks in the AREDF group (p = .001). No statistically significant difference was found between the Doppler groups in the composite adverse neonatal outcome, which includes at least one of the following outcomes: infant respiratory distress syndrome, sepsis, bronchopulmonary dysplasia, necrotizing enterocolitis, intraventricular hemorrhage >grade 2, periventricular leukomalacia and perinatal death (p = .63). Conclusions In this study, comprising pregnancies with early‐onset fetal growth restriction, fetal distress was observed more frequently in the AREDF group with the consequence of delivery at an earlier stage of gestation, compared with the PEDF group. AREDF was not associated with increased perinatal morbidity and mortality compared with PEDF.
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Affiliation(s)
- Diana Gairabekova
- Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Johannes J Duvekot
- Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
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18
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Ceulemans M, Cuppers B, de Vries L, Allegaert K, Duvekot JJ, van Puijenbroek EP. [COVID-19 during pregnancy and lactation: what do we already know?]. Ned Tijdschr Geneeskd 2021; 164:D5036. [PMID: 33560604] [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: 06/12/2023]
Abstract
SARS-CoV-2 has rapidly spread worldwide since December 2019. Obviously, pregnant and lactating women will also be infected with SARS-CoV-2. Pregnant women, however, are a risk population for developing severe respiratory infections. Currently, the knowledge on potential risks and consequences of COVID-19 during pregnancy and lactation is limited. Available data show that pregnant women suffer from similar symptoms compared to non-pregnant patients. There is no evidence as yet that COVID-19 has a more serious course during pregnancy. Although pregnant women might suffer from a wide variety of symptoms, most of them are asymptomatic. Maternal SARS-CoV-2 infection might lead to adverse neonatal outcomes, such as prematurity or respiratory symptoms. There is currently no conclusive evidence of absence of intrauterine transmission of the virus; the virus has not been detected in breastmilk in most studies, although passage into breastmilk cannot be completely excluded.
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Affiliation(s)
| | - B Cuppers
- Lareb, Teratologie Informatie Service, 's-Hertogenbosch
| | - L de Vries
- Lareb, Teratologie Informatie Service, 's-Hertogenbosch
| | - K Allegaert
- KU Leuven, Dept. Farmaceutische en Farmacologische Wetenschappen, Onderzoeksgroep Klinische farmacologie en farmacotherapie, Leuven
| | | | - E P van Puijenbroek
- Lareb, Teratologie Informatie Service, 's-Hertogenbosch
- Contact: E. P. van Puijenbroek
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19
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Baris L, Ladouceur M, Johnson MR, Kozelj M, Festa P, Caruana M, Chee KH, Gilljam T, Ortiz EM, Duvekot JJ, Hall R, Roos-Hesselink JW. Pregnancy in Tetralogy of Fallot data from the ESC EORP ROPAC registry. International Journal of Cardiology Congenital Heart Disease 2021. [DOI: 10.1016/j.ijcchd.2020.100059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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20
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Maggen C, Wolters V, Van Calsteren K, Cardonick E, Laenen A, Gziri MM, Fruscio R, Duvekot JJ, Painter R, Masturzo B, Shmakov R, Halaska M, Berveiller P, Verheecke M, de Haan J, Gordijn S, Heimovaara J, Amant F. 402 Impact of chemotherapy during pregnancy on neonatal birthweight. Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2020.12.423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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21
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Güzel C, van den Berg CB, Koopman S, van Krugten RJ, Stoop M, Stingl C, Duvekot JJ, Luider TM. Cerebrospinal Fluid of Preeclamptic and Normotensive Pregnant Women Compared to Nonpregnant Women Analyzed with Mass Spectrometry. ACS Omega 2020; 5:32256-32266. [PMID: 33376863 PMCID: PMC7758887 DOI: 10.1021/acsomega.0c03910] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 11/13/2020] [Indexed: 06/01/2023]
Abstract
Preeclampsia is a pregnancy-specific multiorgan disorder in which impaired placental functioning and excessive oxidative stress play an important role. We previously showed distinct differences between cerebrospinal fluid proteins in patients with preeclampsia and normotensive pregnant women. An additional group of nonpregnant women was included to study the presence of pregnancy-related proteins in normotensive and preeclamptic pregnancies and whether pregnancy-related proteins were associated with preeclampsia. Cerebrospinal fluid samples were tryptically digested and subsequently measured with a nano-LC-tribrid Orbitrap mass spectrometry system. Proteins were identified by shotgun proteomic analysis based on a data-dependent acquisition method. Proteins identified in preeclampsia, normotensive pregnant controls, and nonpregnant groups were compared to the Progenesis method according to the criteria as previously described and with a secondary analysis using a Scaffold method including Benjamini-Hochberg correction for multiple testing. For preeclampsia, the Progenesis and the Scaffold method together identified 15 (eight proteins for both analyses with one overlap) proteins that were significantly different compared to normotensive control pregnancies. Three of these 15 proteins, which were elevated in cerebrospinal fluid of preeclamptic women, were described to be pregnancy proteins with a calcium-binding function. Using two analysis methods (Progenesis and Scaffold), four out of 15 differential proteins were associated with pregnancy, as described in the literature. Three out of the four pregnancy-related proteins were elevated in preeclampsia. Furthermore, the contribution of elevated (n = 4/15) and downregulated (n = 2/15) calcium-binding proteins in preeclampsia is remarkably high (40%) and needs to be elucidated further.
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Affiliation(s)
- Coşkun Güzel
- Laboratory of Neuro-Oncology/Clinical & Cancer Proteomics, Department of Neurology, Erasmus University Medical Center, Room AE 312, Wytemaweg 80, Rotterdam 3015 CN, The Netherlands
| | - Caroline B van den Berg
- Department of Obstetrics and Gynecology, Erasmus University Medical Center, Rotterdam 3015 GD, The Netherlands
| | - Seppe Koopman
- Department of Anesthesiology, Maasstad Hospital, Rotterdam 3079 DZ, The Netherlands
| | | | - Marcel Stoop
- Laboratory of Neuro-Oncology/Clinical & Cancer Proteomics, Department of Neurology, Erasmus University Medical Center, Room AE 312, Wytemaweg 80, Rotterdam 3015 CN, The Netherlands
| | - Christoph Stingl
- Laboratory of Neuro-Oncology/Clinical & Cancer Proteomics, Department of Neurology, Erasmus University Medical Center, Room AE 312, Wytemaweg 80, Rotterdam 3015 CN, The Netherlands
| | - Johannes J Duvekot
- Department of Obstetrics and Gynecology, Erasmus University Medical Center, Rotterdam 3015 GD, The Netherlands
| | - Theo M Luider
- Laboratory of Neuro-Oncology/Clinical & Cancer Proteomics, Department of Neurology, Erasmus University Medical Center, Room AE 312, Wytemaweg 80, Rotterdam 3015 CN, The Netherlands
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22
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Benschop L, Brouwers L, Zoet GA, Meun C, Boersma E, Budde RPJ, Fauser BCJM, de Groot CMJ, van der Schouw YT, Maas AHEM, Velthuis BK, Linstra KM, Kavousi M, Duvekot JJ, Franx A, Steegers E, van Rijn BB, Roeters van Lennep JE. Early Onset of Coronary Artery Calcification in Women With Previous Preeclampsia. Circ Cardiovasc Imaging 2020; 13:e010340. [PMID: 33190533 DOI: 10.1161/circimaging.119.010340] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Preeclampsia, coronary artery calcification (CAC), and atherosclerotic plaque are risk factors for the development of cardiovascular disease. We determined at what age CAC becomes apparent on coronary computed tomography after preeclampsia and to what extent modifiable cardiovascular risk factors were associated. METHODS We measured cardiovascular risk factors, CAC by coronary computed tomography, and coronary plaque by coronary computed tomography angiography in 258 previously preeclamptic women aged 40-63. Results were compared to 644 age- and ethnicity-equivalent women from the Framingham Heart Study with previous normotensive pregnancies. RESULTS Any CAC was more prevalent after preeclampsia than after a normotensive pregnancy (20% versus 13%). However, this difference was greatest and statistically significant only in women ages 45 to 50 (23% versus 10%). The degree of CAC advanced 4× faster between the ages of 40 to 45 and ages 45 to 50 in women with a history of preeclampsia (odds ratio, 4.3 [95% CI, 1.5-12.2] versus odds ratio, 1.2 [95% CI, 0.6-2.3]). Women with a preeclampsia history maintained greater advancement of CAC with age into their early 60s, although this difference declined after the perimenopausal years. Women with a previous normotensive pregnancy were 4.9 years (95% CI, 1.8-8.0) older when they had similar CAC scores as previously preeclamptic women. These observations were not explained by the greater prevalence of cardiovascular disease risk factors, and the higher Framingham Risk Scores also observed in women with a history of preeclampsia. CONCLUSIONS Previously preeclamptic women have more modifiable cardiovascular risk factors and develop CAC ≈5 years earlier from the age of 45 years onwards compared to women with normotensive pregnancies. Therefore, women who experienced preeclampsia might benefit from regular cardiovascular screening and intervention before this age. Registration: URL: https://www.trialregister.nl/trial/5406; Unique identifier: NTR5531.
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Affiliation(s)
- Laura Benschop
- Department of Obstetrics and Gynecology (L. Benschop, C.M., J.J.D., E.S., B.B.v.R.), University Medical Center Rotterdam, the Netherlands
| | - Laura Brouwers
- Department of Obstetrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, the Netherlands (L. Brouwers, G.A.Z., A.F., B.B.v.R.)
| | - Gerbrand A Zoet
- Department of Obstetrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, the Netherlands (L. Brouwers, G.A.Z., A.F., B.B.v.R.)
| | - Cindy Meun
- Department of Obstetrics and Gynecology (L. Benschop, C.M., J.J.D., E.S., B.B.v.R.), University Medical Center Rotterdam, the Netherlands
| | - Eric Boersma
- Department of Cardiology (E.B.), University Medical Center Rotterdam, the Netherlands
| | - Ricardo P J Budde
- Department of Radiology and Nuclear Medicine (R.P.J.B.), and Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Bart C J M Fauser
- Department of Reproductive Medicine and Gynecology (B.C.J.M.F.), University Medical Center Utrecht, the Netherlands
| | | | - Yvonne T van der Schouw
- Department of Epidemiology of Chronic Disease (Y.T.v.d.S.), University Medical Center Utrecht, the Netherlands
| | - Angela H E M Maas
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands (A.H.E.M.M.)
| | - Birgitta K Velthuis
- Department of Radiology (B.K.V.), University Medical Center Utrecht, the Netherlands
| | - Katie M Linstra
- Department of Neurology, Leids University Medical Center, Leiden, the Netherlands (K.M.L.)
| | | | - Johannes J Duvekot
- Department of Obstetrics and Gynecology (L. Benschop, C.M., J.J.D., E.S., B.B.v.R.), University Medical Center Rotterdam, the Netherlands
| | - Arie Franx
- Department of Obstetrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, the Netherlands (L. Brouwers, G.A.Z., A.F., B.B.v.R.)
| | - Eric Steegers
- Department of Obstetrics and Gynecology (L. Benschop, C.M., J.J.D., E.S., B.B.v.R.), University Medical Center Rotterdam, the Netherlands
| | - Bas B van Rijn
- Department of Obstetrics and Gynecology (L. Benschop, C.M., J.J.D., E.S., B.B.v.R.), University Medical Center Rotterdam, the Netherlands.,Department of Obstetrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, the Netherlands (L. Brouwers, G.A.Z., A.F., B.B.v.R.)
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23
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Maggen C, Dierickx D, Cardonick E, Mhallem Gziri M, Cabrera-Garcia A, Shmakov RG, Avivi I, Masturzo B, Duvekot JJ, Ottevanger PB, O'Laughlin A, Polushkina E, Van Calsteren K, Woei-A-Jin FJSH, Amant F. Maternal and neonatal outcomes in 80 patients diagnosed with non-Hodgkin lymphoma during pregnancy: results from the International Network of Cancer, Infertility and Pregnancy. Br J Haematol 2020; 193:52-62. [PMID: 32945547 DOI: 10.1111/bjh.17103] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 06/22/2020] [Revised: 08/14/2020] [Accepted: 08/19/2020] [Indexed: 12/15/2022]
Abstract
This cohort study of the International Network on Cancer, Infertility and Pregnancy (INCIP) reports the maternal and neonatal outcomes of 80 pregnant patients diagnosed with non-Hodgkin lymphoma (NHL) between 1986 and 2019, focussing on 57 (71%) patients with diffuse large B-cell lymphoma (DLBCL). Of all 80 patients, 54 (68%) pregnant patients received chemotherapy; mostly (89%) CHOP-like (cyclophosphamide, doxorubicin, vincristine, and prednisone) regimens. Four early pregnancies were terminated. Among 76 ongoing pregnancies, there was one stillbirth (1·3%). Overall, there was a high incidence of small for gestational age neonates (39%), preterm delivery (52%), obstetric (41%) and neonatal complications (12·5%), and this could not exclusively be explained by the receipt of antenatal chemotherapy. Half of preterm deliveries (46%) were planned in order to tailor oncological treatment. The 3-year progression-free and overall survival for patients with DLBCL treated with rituximab-CHOP was 83·4% and 95·7% for limited stage (n = 29) and 60·6% and 73·3% for advanced stage (n = 15). Of 36 pregnant patients who received rituximab, five (13%) cases with neonatal complications and three (8%) with maternal infections were reported. In conclusion, standard treatment for DLBCL can be offered to pregnant patients in obstetric centres that cater for high-risk patients.
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Affiliation(s)
| | - Daan Dierickx
- Department of Oncology, KU Leuven, Leuven, Belgium.,Department of Haematology, University Hospitals Leuven, Leuven, Belgium
| | - Elyce Cardonick
- Department of Obstetrics and Gynaecology, Cooper, University Health Care, Camden, NJ, USA
| | - Mina Mhallem Gziri
- Department of Obstetrics, Cliniques Universitaires St Luc, UCL, Sint-Lambrechts-Woluwe, Belgium
| | - Alvaro Cabrera-Garcia
- Hospital Regional de Alta Especialidad de Ixtapaluca (HRAEI) "Reference clinic for haemato-oncological diseases during pregnancy CREHER", Estado de México, México
| | - Roman G Shmakov
- National Medical Research Centre for Obstetrics, Gynaecology and Perinatology named after Academician V.I. Kulakov of the Ministry of Healthcare of Russian Federation, Moscow, Russia
| | - Irit Avivi
- Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel.,Sackler Faculty of Medicine, TA University, Tel Aviv, Israel
| | - Bianca Masturzo
- Department Surgical Sciences, University of Torino, Torino, Italy
| | - Johannes J Duvekot
- Department of Obstetrics and Gynaecology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Petronella B Ottevanger
- Department of Medical Oncology, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
| | | | - Evgeniya Polushkina
- National Medical Research Centre for Obstetrics, Gynaecology and Perinatology named after Academician V.I. Kulakov of the Ministry of Healthcare of Russian Federation, Moscow, Russia
| | - Kristel Van Calsteren
- Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium.,Department of Development and regeneration, KU Leuven, Leuven, Belgium
| | - F J Sherida H Woei-A-Jin
- Department of Oncology, KU Leuven, Leuven, Belgium.,Department of General Medical Oncology, University Hospitals Leuven, Leuven Cancer Institute, KU Leuven, Leuven, Belgium
| | - Frédéric Amant
- Department of Oncology, KU Leuven, Leuven, Belgium.,Department of Gynaecological Oncology, Amsterdam University Medical Centres, Amsterdam, The Netherlands.,Department of Gynaecology, Antoni van Leeuwenhoek - Netherlands Cancer Institute, Amsterdam, The Netherlands
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Duvekot JJ, Duijnhoven RG, van Horen E, Bax CJ, Bloemenkamp KW, Brussé IA, Dijk PH, Franssen MT, Franx A, Oudijk MA, Porath MM, Scheepers HC, van Wassenaer-Leemhuis AG, van Drongelen J, Mol BW, Ganzevoort W. Temporizing management vs immediate delivery in early-onset severe preeclampsia between 28 and 34 weeks of gestation (TOTEM study): An open-label randomized controlled trial. Acta Obstet Gynecol Scand 2020; 100:109-118. [PMID: 33319930 PMCID: PMC7754130 DOI: 10.1111/aogs.13976] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 08/02/2020] [Accepted: 08/09/2020] [Indexed: 12/11/2022]
Abstract
Introduction There is little evidence to guide the timing of delivery of women with early‐onset severe preeclampsia. We hypothesize that immediate delivery is not inferior for neonatal outcome but reduces maternal complications compared with temporizing management. Material and methods This Dutch multicenter open‐label randomized clinical trial investigated non‐inferiority for neonatal outcome of temporizing management as compared with immediate delivery (TOTEM NTR 2986) in women between 27+5 and 33+5 weeks of gestation admitted for early‐onset severe preeclampsia with or without HELLP syndrome. In participants allocated to receive immediate delivery, either induction of labor or cesarean section was initiated at least 48 hours after admission. Primary outcomes were adverse perinatal outcome, defined as a composite of severe respiratory distress syndrome, bronchopulmonary dysplasia, culture proven sepsis, intraventricular hemorrhage grade 3 or worse, periventricular leukomalacia grade 2 or worse, necrotizing enterocolitis stage 2 or worse, and perinatal death. Major maternal complications were secondary outcomes. It was estimated 1130 women needed to be enrolled. Analysis was by intention‐to‐treat. Results The trial was halted after 35 months because of slow recruitment. Between February 2011 and December 2013, a total of 56 women were randomized to immediate delivery (n = 26) or temporizing management (n = 30). Median gestational age at randomization was 30 weeks. Median prolongation of pregnancy was 2 days (interquartile range 1‐3 days) in the temporizing management group. Mean birthweight was 1435 g after immediate delivery vs 1294 g after temporizing management (P = .14). The adverse perinatal outcome rate was 55% in the immediate delivery group vs 52% in the temporizing management group (relative risk 1.06; 95% confidence interval 0.67‐1.70). In both groups there was one neonatal death and no maternal deaths. In the temporizing treatment group, one woman experienced pulmonary edema and one placental abruption. Analyses of only the singleton pregnancies did not result in other outcomes. Conclusions Early termination of the trial precluded any conclusions for the main outcomes. We observed that temporizing management resulted in a modest prolongation of pregnancy without changes in perinatal and maternal outcome. Conducting a randomized study for this important research question did not prove feasible.
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Affiliation(s)
- Johannes J Duvekot
- Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ruben G Duijnhoven
- Department of Obstetrics and Gynecology, Amsterdam University Medical Center, Amsterdam Medical Center, Amsterdam, The Netherlands
| | - Eva van Horen
- Department of Obstetrics and Gynecology, Amsterdam University Medical Center, Amsterdam Medical Center, Amsterdam, The Netherlands
| | - Caroline J Bax
- Department of Obstetrics and Gynecology, Amsterdam University Medical Center, Amsterdam Medical Center, Amsterdam, The Netherlands
| | - Kitty W Bloemenkamp
- Department of Obstetrics, Division Woman and Baby, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ingrid A Brussé
- Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Peter H Dijk
- Department of Neonatology, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Maureen T Franssen
- Department of Obstetrics and Gynecology, University Medical Center Groningen, Groningen, The Netherlands
| | - Arie Franx
- Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Martijn A Oudijk
- Department of Obstetrics and Gynecology, Amsterdam University Medical Center, Amsterdam Medical Center, Amsterdam, The Netherlands
| | - Martina M Porath
- Department of Obstetrics and Gynecology, Maxima Medical Center, Veldhoven, The Netherlands
| | - Hubertina C Scheepers
- Department of Obstetrics and Gynecology, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | - Joris van Drongelen
- Department of Obstetrics and Gynecology, Radboud University Medical Cernter, Nijmegen, The Netherlands
| | - Ben W Mol
- Department of Obstetrics and Gynecology, Amsterdam University Medical Center, Amsterdam Medical Center, Amsterdam, The Netherlands.,Department of Obstetrics and Gynecology, Monash University, Clayton, VIC, Australia
| | - Wessel Ganzevoort
- Department of Obstetrics and Gynecology, Amsterdam University Medical Center, Amsterdam Medical Center, Amsterdam, The Netherlands
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25
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Moors X, Biesheuvel TH, Cornette J, Van Vledder MG, Veen A, de Quelerij M, Weelink E, Duvekot JJ. Analysis of prehospital perimortem caesarean deliveries performed by Helicopter Emergency Medical Services in the Netherlands and recommendations for the future. Resuscitation 2020; 155:112-118. [PMID: 32745580 DOI: 10.1016/j.resuscitation.2020.07.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 04/18/2020] [Revised: 07/08/2020] [Accepted: 07/19/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Prehospital perimortem caesarean delivery (PCD) is a rarely performed procedure. In this study, we aimed to examine all PCDs performed by the four Helicopter Emergency Medical Services in the Netherlands; to describe the procedures, outcomes, complications, and compliance with the recommended guidelines; and to formulate recommendations. METHODS We performed a population-based retrospective cohort study of all consecutive maternal out-of-hospital cardiac arrests that underwent PCD in the prehospital setting between May 1995 and December 2019. Registered data included patient demographics, operator background, advanced life support interventions, and timelines. Resuscitation performance was evaluated according to the 2015 European Resuscitation Guidelines. RESULTS Seven patients underwent a prehospital PCD. Three mothers died on the scene, while four were transported to a hospital but died in the hospital. Seven neonates were born by PCD. One neonate died on the scene and six were transported to a hospital. Three neonates were eventually discharged from the hospital. Among the three surviving neonates, the periods from dispatch to start of PCD were 13, 14, and 21 min. CONCLUSIONS There was a low incidence of maternal perimortem caesarean deliveries in The Netherlands. Only some neonates survived after PCD. It is recommended that PCD be performed as quickly as possible. Due to the delay, the mother has a far lower chance of survival than the neonate. In fatal cases, autopsy is strongly recommended.
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Affiliation(s)
- Xrj Moors
- Department of Anaesthesiology, Erasmus MC, University Medical Center Rotterdam-Sophia Children's Hospital, Rotterdam, The Netherlands; HEMS, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - T H Biesheuvel
- Department of Surgery and HEMS, VU University Medical Center, Amsterdam, The Netherlands
| | - J Cornette
- Department of Obstetrics and Gynaecology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - M G Van Vledder
- HEMS, Erasmus University Medical Center, Rotterdam, The Netherlands; Trauma Research Unit, Department of Surgery ErasmusMC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - A Veen
- HEMS, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - M de Quelerij
- Department of Anaesthesiology, Franciscus Hospital Rotterdam, The Netherlands
| | - Eem Weelink
- Department of Anaesthesiology and HEMS, University Medical Center Groningen, University of Groningen, The Netherlands
| | - J J Duvekot
- Department of Obstetrics and Gynaecology, Erasmus University Medical Center, Rotterdam, The Netherlands
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Bouter AR, Duvekot JJ. Evaluation of the clinical impact of the revised ISSHP and ACOG definitions on preeclampsia. Pregnancy Hypertens 2020; 19:206-211. [DOI: 10.1016/j.preghy.2019.11.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 11/03/2019] [Accepted: 11/25/2019] [Indexed: 10/25/2022]
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Benschop L, Schelling SJ, Duvekot JJ, Roeters van Lennep JE. Cardiovascular health and vascular age after severe preeclampsia: A cohort study. Atherosclerosis 2019; 292:136-142. [PMID: 31805453 DOI: 10.1016/j.atherosclerosis.2019.11.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 11/12/2019] [Accepted: 11/27/2019] [Indexed: 01/24/2023]
Abstract
BACKGROUND AND AIMS Severe preeclampsia increases lifetime-risk for cardiovascular disease (CVD). It remains unclear when this risk translates to subclinical atherosclerosis and whether this is related to cardiovascular health (CVH) after pregnancy. Our aims were (1) to determine CVH after severe preeclampsia, (2) to relate CVH to carotid intima-media thickness (CIMT), as a marker of subclinical atherosclerosis and (3) to relate CVH to chronological and vascular age. METHODS A prospective cohort study was performed in women with previous severe pre-eclampsia. CVH, proposed by the American Heart Association, was assessed one year after pregnancy. The CVH score (range 0-14) includes seven metrics (blood pressure, total-cholesterol, glucose, smoking, physical activity, diet and body mass index [BMI]), each weighted as poor (0), intermediate (1) or ideal (2). Vascular age was determined by CIMT. We related CVH to delta age (chronological age - vascular age). RESULTS In 244 women, the median CVH score was 10 (90% range 7.0, 13.0). Low CVH (<10) was associated with a larger CIMT than high CVH (≥12) (median 626.3 μm vs. 567.0 μm, respectively). Higher CVH was also associated with a lower vascular age (-2.0 years, 95%CI -3.3, -0.60). Women with low CVH had a larger delta age (22.5 years [90% range -3.9, 49.6) than women with high CVH (16.5 years [90% range -11.9, 43.3). CONCLUSIONS CVH is inversely related to subclinical atherosclerosis and to vascular age one year after severe preeclampsia. Especially low CVH is associated with a large difference between chronological age and vascular age. CVH counseling might provide the opportunity for timely cardiovascular prevention.
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Affiliation(s)
- Laura Benschop
- Department of Obstetrics and Gynecology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Sara Jc Schelling
- Department of Obstetrics and Gynecology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Johannes J Duvekot
- Department of Obstetrics and Gynecology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
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28
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Bijl RC, Cornette JMJ, van den Bosch AE, Duvekot JJ, Molinger J, Willemsen SP, Koning AHJ, Roos-Hesselink JW, Franx A, Steegers-Theunissen RPM, Koster MPH. Study protocol for a prospective cohort study to investigate Hemodynamic Adaptation to Pregnancy and Placenta-related Outcome: the HAPPO study. BMJ Open 2019; 9:e033083. [PMID: 31712350 PMCID: PMC6858161 DOI: 10.1136/bmjopen-2019-033083] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION The importance of cardiovascular health in relation to pregnancy outcome is increasingly acknowledged. Women who develop certain pregnancy complications, in particular preeclampsia, are at higher risk for future cardiovascular disease. Independent of its outcome, pregnancy requires a substantial adaptive response of the maternal cardiovascular system. In the Hemodynamic Adaptation to Pregnancy and Placenta-related Outcome (HAPPO) study, we aim to examine longitudinal maternal haemodynamic adaptation to pregnancy from the preconception period onwards. We hypothesise that women who will develop adverse pregnancy outcomes have impaired cardiovascular health before conception, leading to haemodynamic maladaptation to pregnancy and diminished uteroplacental vascular development. METHODS AND ANALYSIS In this prospective cohort study embedded in the Rotterdam periconception cohort, 200 women with a history of placenta-related pregnancy complications (high-risk group) and 100 women with an uncomplicated obstetric history (low-risk group) will be included. At five moments (preconception, first, second and third trimester and postdelivery), women will undergo an extensive examination of the macrocirculatory and microcirculatory system and uteroplacental vascular development. The main outcome measures are differences in maternal haemodynamic adaptation to pregnancy between women with and without placenta-related pregnancy complications. In a multivariate linear mixed model, the relationship between maternal haemodynamic adaptive parameters, (utero)placental vascularisation indices and clinical outcomes (occurrence of pregnancy complications, embryonic and fetal growth trajectories, miscarriage rate, gestational age at delivery, birth weight) will be studied. Subgroup analysis will be performed to study baseline and trajectory differences between high-risk and low-risk women, independent of subsequent pregnancy outcome. ETHICS AND DISSEMINATION This study protocol was approved by the Medical Ethics Committee of the Erasmus MC, Rotterdam, the Netherlands (MEC 2018-150). Results will be disseminated to the medical community by publications in peer-reviewed journals and presentations at scientific congresses. Also, patient associations will be informed and the public will be informed by dissemination through (social) media. TRIAL REGISTRATION NUMBER NL7394 (www.trialregister.nl).
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Affiliation(s)
- Rianne C Bijl
- Department of Obstetrics and Gynecology, Erasmus MC, Rotterdam, The Netherlands
| | - Jérôme M J Cornette
- Department of Obstetrics and Gynecology, Erasmus MC, Rotterdam, The Netherlands
| | | | - Johannes J Duvekot
- Department of Obstetrics and Gynecology, Erasmus MC, Rotterdam, The Netherlands
| | - Jeroen Molinger
- Department of Intensive Care Adults, Erasmus MC, Rotterdam, The Netherlands
- Department of Anesthesiology & Intensive Care Medicine, Human Physiology and Pharmacology Lab (HPPL), Duke Medicine, Durham, North Carolina, USA
| | - Sten P Willemsen
- Department of Obstetrics and Gynecology, Erasmus MC, Rotterdam, The Netherlands
- Department of Biostatistics, Erasmus MC, Rotterdam, The Netherlands
| | | | | | - Arie Franx
- Department of Obstetrics and Gynecology, Erasmus MC, Rotterdam, The Netherlands
| | | | - Maria P H Koster
- Department of Obstetrics and Gynecology, Erasmus MC, Rotterdam, The Netherlands
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29
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Veen CSB, van der Reijken IS, Jansen AJG, Schipaanboord CWA, Visser W, de Maat MPM, Leebeek FWG, Duvekot JJ, Kruip MJHA. Severe postpartum haemorrhage as first presenting symptom of an inherited bleeding disorder. Haemophilia 2019; 25:1051-1058. [PMID: 31583797 DOI: 10.1111/hae.13846] [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: 07/01/2019] [Revised: 08/11/2019] [Accepted: 08/23/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Postpartum haemorrhage (PPH) is the major cause of maternal death worldwide. Haemostatic abnormalities are independently associated with a significantly increased risk for severe PPH. In this study, the value of haemostatic evaluation in women with severe PPH was explored. AIM To investigate the occurrence of previously unknown inherited bleeding disorders in women with severe PPH. METHODS Women with severe PPH (blood loss of ≥2000 mL) between 2011 and 2017, referred to the haematology outpatient clinic for haemostatic evaluation, were retrospectively included. A bleeding disorder was diagnosed based on (inter)national guidelines, or when having a clear bleeding phenotype, not fulfilling any diagnostic criteria or laboratory abnormalities, this being classified as Bleeding of Unknown Cause (BUC). Logistic regression was used to model the association between diagnosis and obstetrical causes and risk factors for PPH. RESULTS In total, 85 women with PPH were included. In 23% (n = 16), a mild bleeding disorder was diagnosed, including low von Willebrand factor (Low VWF 8/16), platelet function disorders (PFD 5/16), BUC (2/16) and von Willebrand disease type 1 (1/16). No significant associations were found between obstetrical causes or risk factors for PPH and the presence of a bleeding disorder. CONCLUSION In 23% of women with severe PPH, a mild bleeding disorder was diagnosed, independent of obstetrical causes or risk factors for PPH. This implies that severe PPH can be the first clinical symptom of an inherited bleeding disorder. Therefore, to optimize clinical management, haemostatic evaluation after severe PPH is recommended.
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Affiliation(s)
- Caroline S B Veen
- Department of Haematology, Erasmus University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Irene S van der Reijken
- Department of Haematology, Erasmus University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - A J Gerard Jansen
- Department of Haematology, Erasmus University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | | | - Willy Visser
- Department of Obstetrics & Gynaecology, Erasmus University Medical Centre Rotterdam, Rotterdam, The Netherlands.,Department of Vascular Medicine, Erasmus University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Moniek P M de Maat
- Department of Haematology, Erasmus University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Frank W G Leebeek
- Department of Haematology, Erasmus University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Johannes J Duvekot
- Department of Obstetrics & Gynaecology, Erasmus University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Marieke J H A Kruip
- Department of Haematology, Erasmus University Medical Centre Rotterdam, Rotterdam, The Netherlands
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30
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Benschop L, Duvekot JJ, Roeters van Lennep JE. Future risk of cardiovascular disease risk factors and events in women after a hypertensive disorder of pregnancy. Heart 2019; 105:1273-1278. [PMID: 31175138 PMCID: PMC6678044 DOI: 10.1136/heartjnl-2018-313453] [Citation(s) in RCA: 127] [Impact Index Per Article: 25.4] [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] [Received: 11/22/2018] [Revised: 05/10/2019] [Accepted: 05/13/2019] [Indexed: 02/06/2023] Open
Abstract
Hypertensive disorders of pregnancy (HDP), such as gestational hypertension and pre-eclampsia, affect up to 10% of all pregnancies. These women have on average a twofold higher risk to develop cardiovascular disease (CVD) later in life as compared with women with normotensive pregnancies. This increased risk might result from an underlying predisposition to CVD, HDP itself or a combination of both. After pregnancy women with HDP show an increased risk of classical cardiovascular risk factors including chronic hypertension, renal dysfunction, dyslipidemia, diabetes and subclinical atherosclerosis. The prevalence and onset of cardiovascular risk factors depends on the severity of the HDP and the coexistence of other pregnancy complications. At present, guidelines addressing postpartum cardiovascular risk assessment for women with HDP show a wide variation in their recommendations. This makes cardiovascular follow-up of women with a previous HDP confusing and non-coherent. Some guidelines advise to initiate cardiovascular follow-up (blood pressure, weight and lifestyle assessment) 6-8 weeks after pregnancy, whereas others recommend to start 6-12 months after pregnancy. Concurrent blood pressure monitoring, lipid and glucose assessment is recommended to be repeated annually to every 5 years until the age of 50 years when women will qualify for cardiovascular risk assessment according to all international cardiovascular prevention guidelines.
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Affiliation(s)
- Laura Benschop
- Department of Obstetrics and Gynaecology, Erasmus MC, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Johannes J Duvekot
- Department of Obstetrics and Gynaecology, Erasmus MC, Rotterdam, The Netherlands
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31
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de Vries TW, Duvekot JJ, Ter Horst PGJ. [Medication use during pregnancy and lactation; urgent need for one independent source of information]. Ned Tijdschr Geneeskd 2019; 163:D3639. [PMID: 31283123] [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: 06/09/2023]
Abstract
It is important for healthcare professionals and pregnant women to have knowledge of the risks of using medicines during pregnancy and lactation. This not only concerns the influence of the medicinal product on the pregnant woman and the pregnancy, but also its impact on the growth and development of the (unborn) child, neonatal adaptation, possible precautions regarding child-birth, drug excretion in breast milk, and the short-term and long-term consequences for the newborn child. At present, information and advices are often fragmentary, sometimes contradictory, not easily accessible, or even not available at all. It is high time for one independent source to provide unambiguous, scientifically substantiated information and advice, accessible to both healthcare professionals and pregnant women - preferably in a digital format.
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Affiliation(s)
- Tjalling W de Vries
- Medisch Centrum Leeuwarden, afd. Kindergeneeskunde, Leeuwarden
- Contact: T.W. de Vries
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32
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Collins SL, Alemdar B, van Beekhuizen HJ, Bertholdt C, Braun T, Calda P, Delorme P, Duvekot JJ, Gronbeck L, Kayem G, Langhoff-Roos J, Marcellin L, Martinelli P, Morel O, Mhallem M, Morlando M, Noergaard LN, Nonnenmacher A, Pateisky P, Petit P, Rijken MJ, Ropacka-Lesiak M, Schlembach D, Sentilhes L, Stefanovic V, Strindfors G, Tutschek B, Vangen S, Weichert A, Weizsäcker K, Chantraine F. Evidence-based guidelines for the management of abnormally invasive placenta: recommendations from the International Society for Abnormally Invasive Placenta. Am J Obstet Gynecol 2019; 220:511-526. [PMID: 30849356 DOI: 10.1016/j.ajog.2019.02.054] [Citation(s) in RCA: 170] [Impact Index Per Article: 34.0] [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: 11/29/2018] [Revised: 02/13/2019] [Accepted: 02/27/2019] [Indexed: 11/28/2022]
Abstract
The worldwide incidence of abnormally invasive placenta is rapidly rising, following the trend of increasing cesarean delivery. It is a heterogeneous condition and has a high maternal morbidity and mortality rate, presenting specific intrapartum challenges. Its rarity makes developing individual expertise difficult for the majority of clinicians. The International Society for Abnormally Invasive Placenta aims to improve clinicians' understanding and skills in managing this difficult condition. By pooling knowledge, experience, and expertise gained within a variety of different healthcare systems, the Society seeks to improve the outcomes for women with abnormally invasive placenta globally. The recommendations presented herewith were reached using a modified Delphi technique and are based on the best available evidence. The evidence base for each is presented using a formal grading system. The topics chosen address the most pertinent questions regarding intrapartum management of abnormally invasive placenta with respect to clinically relevant outcomes, including the following: definition of a center of excellence; requirement for antenatal hospitalization; antenatal optimization of hemoglobin; gestational age for delivery; antenatal corticosteroid administration; use of preoperative cystoscopy, ureteric stents, and prophylactic pelvic arterial balloon catheters; maternal position for surgery; type of skin incision; position of the uterine incision; use of interoperative ultrasound; prophylactic administration of oxytocin; optimal method for intraoperative diagnosis; use of expectant management; adjuvant therapies for expectant management; use of local surgical resection; type of hysterectomy; use of delayed hysterectomy; intraoperative measures to treat life-threatening hemorrhage; and fertility after conservative management.
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Affiliation(s)
- Sally L Collins
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK; The Fetal Medicine Unit, John Radcliffe Hospital, Oxford, UK.
| | - Bahrin Alemdar
- Department of Obstetrics and Gynecology, South General Hospital, Stockholm, Sweden
| | | | - Charline Bertholdt
- Centre Hospitalier Régional Universitaire de Nancy, Université de Lorraine, France
| | - Thorsten Braun
- Departments of Obstetrics and Division of Experimental Obstetrics, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Virchow-Klinikum and Campus Charité Mitte, Berlin, Germany
| | - Pavel Calda
- Department of Obstetrics and Gynecology, General Faculty Hospital, Charles University, Prague, Czech Republic
| | - Pierre Delorme
- Port-Royal Maternity Unit, Cochin Hospital, Paris-Descartes University, DHU Risk and Pregnancy, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Johannes J Duvekot
- Department of Obstetrics and Gynecology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands
| | - Lene Gronbeck
- Department of Obstetrics, Rigshospitalet, University of Copenhagen, Denmark
| | - Gilles Kayem
- Department of Obstetrics and Gynecology, Hôpital Trousseau, Assistance Publique des Hôpitaux de Paris, Sorbonne University, Paris, France
| | - Jens Langhoff-Roos
- Department of Obstetrics, Rigshospitalet, University of Copenhagen, Denmark
| | - Louis Marcellin
- Department of Gynecology Obstetrics II and Reproductive Medicine, Hôpitaux Universitaires Paris Centre, Hôpital Cochin, APHP; Sorbonne Paris Cité, Université Paris Descartes, Faculté de Médecine, Paris, France
| | - Pasquale Martinelli
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy
| | - Olivier Morel
- Centre Hospitalier Régional Universitaire de Nancy, Université de Lorraine, France
| | - Mina Mhallem
- Department of Obstetrics, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Maddalena Morlando
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy; Department of Women, Children and of General and Specialized Surgery, University "Luigi Vanvitelli", Naples, Italy
| | - Lone N Noergaard
- Department of Obstetrics, Rigshospitalet, University of Copenhagen, Denmark
| | - Andreas Nonnenmacher
- Departments of Obstetrics and Division of Experimental Obstetrics, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Virchow-Klinikum and Campus Charité Mitte, Berlin, Germany
| | - Petra Pateisky
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-Maternal Medicine, Medical University of Vienna, Vienna, Austria
| | - Philippe Petit
- Department of Obstetrics and Gynecology, CHR Citadelle, University of Liege, Liege, Belgium
| | - Marcus J Rijken
- Vrouw & Baby, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
| | - Mariola Ropacka-Lesiak
- Department of Perinatology and Gynecology, University of Medical Sciences, Poznan, Poland
| | - Dietmar Schlembach
- Vivantes Network for Health, Clinicum Neukoelln, Clinic for Obstetric Medicine, Berlin, Germany
| | - Loïc Sentilhes
- Department of Obstetrics and Gynecology, Hôpital Pellegrin, CHU de Bordeaux, Bordeaux, France
| | - Vedran Stefanovic
- Department of Obstetrics and Gynecology, Fetomaternal Medical Center, Helsinki University Hospital and University of Helsinki, Finland
| | - Gita Strindfors
- Department of Obstetrics and Gynecology, South General Hospital, Stockholm, Sweden
| | - Boris Tutschek
- Prenatal Zurich, Zürich, Switzerland; Heinrich Heine University, Düsseldorf, Germany
| | - Siri Vangen
- Division of Obstetrics and Gynaecology, Norwegian National Advisory Unit on Women's Health, Oslo University Hospital, Rikshospitalet and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Alexander Weichert
- Departments of Obstetrics and Division of Experimental Obstetrics, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Virchow-Klinikum and Campus Charité Mitte, Berlin, Germany
| | - Katharina Weizsäcker
- Departments of Obstetrics and Division of Experimental Obstetrics, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Virchow-Klinikum and Campus Charité Mitte, Berlin, Germany
| | - Frederic Chantraine
- Department of Obstetrics and Gynecology, CHR Citadelle, University of Liege, Liege, Belgium
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Geurtzen R, van Heijst AFJ, Draaisma JMT, Kuijpers LJMK, Woiski M, Scheepers HCJ, van Kaam AH, Oudijk MA, Lafeber HN, Bax CJ, Koper JF, Duin LK, van der Hoeven MA, Kornelisse RF, Duvekot JJ, Andriessen P, van Runnard Heimel PJ, van der Heide-Jalving M, Bekker MN, Mulder-de Tollenaer SM, van Eyck J, Eshuis-Peters E, Graatsma M, Hermens RPMG, Hogeveen M. Development of Nationwide Recommendations to Support Prenatal Counseling in Extreme Prematurity. Pediatrics 2019; 143:peds.2018-3253. [PMID: 31160512 DOI: 10.1542/peds.2018-3253] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [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] [Accepted: 03/25/2019] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To develop a nationwide, evidence-based framework to support prenatal counseling in extreme prematurity, focusing on organization, decision-making, content, and style aspects. METHODS A nationwide multicenter RAND-modified Delphi method study was performed between November 2016 and December 2017 in the Netherlands. Firstly, recommendations were extracted from literature and previous studies. Secondly, an expert panel (n = 21) with experienced parents, obstetricians, and neonatologists rated the recommendations on importance for inclusion in the framework. Thirdly, ratings were discussed in a consensus meeting. The final set of recommendations was approved and transformed into a framework. RESULTS A total of 101 recommendations on organization, decision-making, content, and style were included in the framework, including tools to support personalization. The most important recommendations regarding organization were to have both parents involved in the counseling with both the neonatologist and obstetrician. The shared decision-making model was recommended for deciding between active support and comfort care. Main recommendations regarding content of conversation were explanation of treatment options, information on survival, risk of permanent consequences, impossibility to predict an individual course, possibility for multiple future decision moments, and a discussion on parental values and standards. It was considered important to avoid jargon, check understanding, and provide a summary. The expert panel, patient organization, and national professional associations (gynecology and pediatrics) approved the framework. CONCLUSIONS A nationwide, evidence-based framework for prenatal counseling in extreme prematurity was developed. It contains recommendations and tools for personalization in the domains of organization, decision-making, content, and style of prenatal counseling.
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Affiliation(s)
| | | | | | | | - Mallory Woiski
- Obstetrics and Gynecology, Amalia Children's Hospital and
| | | | | | - Martijn A Oudijk
- Department of Obstetrics and Gynecology, Amsterdam University Medical Center and University of Amsterdam, Amsterdam, Netherlands
| | | | - Caroline J Bax
- Obstetrics and Gynecology, Vrije Universteit Medical Center and Vrije Universteit Amsterdam, Amsterdam, Netherlands
| | | | - Leonie K Duin
- Obstetrics, Gynecology, and Prenatal Diagnosis, University Medical Center Groningen and University of Groningen, Groningen, Netherlands
| | | | | | - Johannes J Duvekot
- Department of Obstetrics and Gynecology, Erasmus University Medical Center, Rotterdam, Netherlands
| | | | | | | | - Mireille N Bekker
- Obstetrics and Gynecology, Wilhelmina Children's Hospital, University Medical Centre, Utrecht, Netherlands
| | | | - Jim van Eyck
- Obstetrics and Gynecology, Isala Woman and Children's Hospital Zwolle, Zwolle, Netherlands; and
| | - Ellis Eshuis-Peters
- Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, Netherlands
| | | | - Rosella P M G Hermens
- Scientific Institute for Quality of Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
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Güzel C, van den Berg CB, Duvekot JJ, Stingl C, van den Bosch TPP, van der Weiden M, Steegers EAP, Steegers‐Theunissen RPM, Luider TM. Quantification of Calcyclin and Heat Shock Protein 90 in Sera from Women with and without Preeclampsia by Mass Spectrometry. Proteomics Clin Appl 2019; 13:e1800181. [PMID: 30417587 PMCID: PMC6588016 DOI: 10.1002/prca.201800181] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 10/11/2018] [Indexed: 01/28/2023]
Abstract
PURPOSE The objective of present study is to determine serum levels and placental distribution of two interacting proteins calcyclin and heat shock protein 90 in preeclampsia. EXPERIMENTAL DESIGN Maternal serum levels of calcyclin and heat shock protein 90 are compared throughout pregnancy from the first trimester till term among women with preeclampsia (n = 43) and age-matched normotensive pregnant controls (n = 46). A serum-based 2D LC-MS assay using Parallel Reaction Monitoring is applied to quantify both calcyclin and heat shock protein 90. RESULTS Serum levels of calcyclin are significantly lower in patients with preeclampsia in the second trimester of pregnancy as compared to controls (p < 0.05). Serum levels of heat shock protein 90 are significantly higher in patients with preeclampsia in the third trimester as compared to controls (p < 0.001). CONCLUSION AND CLINICAL RELEVANCE Both interacting proteins calcyclin and heat shock protein 90 are notably changed in preeclamptic patients compared to controls. Calcyclin is already decreased before the onset of preeclampsia in the second trimester and HSP90 is strongly increased in the third trimester. This suggests that these proteins may play a role in the pathogenesis of preeclampsia and ought to be investigated in large cohort studies as molecular biomarkers.
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Affiliation(s)
- Coşkun Güzel
- Laboratory of Neuro‐Oncology/Clinical and Cancer ProteomicsDepartment of NeurologyErasmus University Medical Center Rotterdam3015 CNRotterdamThe Netherlands
| | - Caroline B. van den Berg
- Departments of Obstetrics and GynecologyErasmus University Medical Center Rotterdam3015 CNRotterdamThe Netherlands
| | - Johannes J. Duvekot
- Departments of Obstetrics and GynecologyErasmus University Medical Center Rotterdam3015 CNRotterdamThe Netherlands
| | - Christoph Stingl
- Laboratory of Neuro‐Oncology/Clinical and Cancer ProteomicsDepartment of NeurologyErasmus University Medical Center Rotterdam3015 CNRotterdamThe Netherlands
| | | | - Marcel van der Weiden
- Department of PathologyErasmus University Medical Center Rotterdam3015 CNRotterdamThe Netherlands
| | - Eric A. P. Steegers
- Departments of Obstetrics and GynecologyErasmus University Medical Center Rotterdam3015 CNRotterdamThe Netherlands
| | | | - Theo M. Luider
- Laboratory of Neuro‐Oncology/Clinical and Cancer ProteomicsDepartment of NeurologyErasmus University Medical Center Rotterdam3015 CNRotterdamThe Netherlands
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Huisman CMA, Ten Eikelder MLG, Mast K, Oude Rengerink K, Jozwiak M, van Dunné F, Duvekot JJ, van Eyck J, Gaugler-Senden I, de Groot CJM, Franssen MTM, van Gemund N, Langenveld J, de Leeuw JW, Oude Lohuis EJ, Oudijk MA, Papatsonis D, van Pampus M, Porath M, Rombout-de Weerd S, van Roosmalen JJ, van der Salm PCM, Scheepers HCJ, Sikkema MJ, Sporken J, Stigter RH, van Wijngaarden WJ, Woiski M, Mol BWJ, Bloemenkamp KWM. Balloon catheter for induction of labor in women with one previous cesarean and an unfavorable cervix. Acta Obstet Gynecol Scand 2019; 98:920-928. [PMID: 30723900 PMCID: PMC6618009 DOI: 10.1111/aogs.13558] [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] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 01/27/2019] [Accepted: 01/29/2019] [Indexed: 12/01/2022]
Abstract
Introduction When women with a previous cesarean section and an unfavorable cervix have an indication for delivery, the choice is to induce labor or to perform a cesarean section. This study aims to assess the effectiveness and safety of a balloon catheter as a method of induction of labor in women with one previous cesarean section and an unfavorable cervix compared with an elective repeat cesarean section. Material and methods We performed a prospective cohort study in 51 hospitals in the Netherlands on term women with one previous cesarean section, a live singleton fetus in cephalic position, an unfavorable cervix and an indication for delivery. We recorded obstetric, maternal and neonatal characteristics. We compared the outcome of women who were induced with a balloon catheter with the outcome of women who delivered by elective repeat cesarean section. Main outcomes were maternal and neonatal morbidity. Mode of delivery was a secondary outcome for women who were induced. Adjusted odds ratios (aOR) were calculated using logistic regression, adjusted for potential confounders. Results Analysis was performed on 993 women who were induced and 321 women who had a repeat cesarean section (August 2011 until September 2012). Among the women who were induced, 560 (56.4%) delivered vaginally and 11 (1.1%) sustained a uterine rupture. Composite adverse maternal outcome (uterine rupture, severe postpartum hemorrhage or postpartum infection) occurred in 73 (7.4%) in the balloon and 14 (4.5%) women in the repeat cesarean section group (aOR 1.58, 95% confidence interval [CI] 0.85‐2.96). Composite adverse neonatal outcome (Apgar score <7 at 5 minutes or umbilical pH <7.10) occurred in 57 (5.7%) and 10 (3.2%) neonates, respectively (aOR 1.40, 95% CI 0.87‐3.48). Women who were induced had a shorter postpartum admission time (2.0 vs 3.0 days (P < 0.0001)). Conclusions In women with a previous cesarean section and a need for delivery, induction of labor with a balloon catheter does not result in a significant increase in adverse maternal and neonatal outcomes as compared with planned cesarean section.
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Affiliation(s)
- Claartje M A Huisman
- Obstetrics and Gynecology, Haaglanden Medical Center, The Hague, the Netherlands
| | | | - Kelly Mast
- Obstetrics and Gynecology, Academic Hospital Maastricht, Maastricht, the Netherlands
| | - Katrien Oude Rengerink
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Marta Jozwiak
- Obstetrics and Gynecology, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Frédérique van Dunné
- Obstetrics and Gynecology, Haaglanden Medical Center, The Hague, the Netherlands
| | - Johannes J Duvekot
- Obstetrics and Gynecology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Jim van Eyck
- Obstetrics and Gynecology, Isala Clinics, Zwolle, the Netherlands
| | | | | | - Maureen T M Franssen
- Obstetrics and Gynecology, University Medical Center Groningen, Groningen, the Netherlands
| | | | - Josje Langenveld
- Obstetrics and Gynecology, Zuyderland Medical Center, Heerlen, the Netherlands
| | | | - Eefje J Oude Lohuis
- Obstetrics and Gynecology, Isala Clinics, Zwolle, the Netherlands.,Obstetrics and Gynecology, Medical Spectrum Twente, Enschede, the Netherlands
| | - Martijn A Oudijk
- Obstetrics and Gynecology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | | | - Mariëlle van Pampus
- Obstetrics and Gynecology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
| | - Martina Porath
- Obstetrics and Gynecology, Maxima Medical Center, Veldhoven, the Netherlands
| | | | - Jos J van Roosmalen
- Obstetrics and Gynecology, Leiden University Medical Center, Leiden, the Netherlands
| | | | | | - Marko J Sikkema
- Obstetrics and Gynecology, Hospital Group Twente (ZGT), Almelo, the Netherlands
| | - Jan Sporken
- Obstetrics and Gynecology, Canisius Hospital, Nijmegen, the Netherlands
| | - Rob H Stigter
- Obstetrics and Gynecology, Deventer Hospital, Deventer, the Netherlands
| | | | - Mallory Woiski
- Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Ben Willem J Mol
- Department of Obstetrics and Gynecology, Monash University, Melbourne, Australia
| | - Kitty W M Bloemenkamp
- Division Women and Baby, Department of Obstetrics, Birth Center Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
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Benschop L, Duvekot JJ, Versmissen J, van Broekhoven V, Steegers EAP, Roeters van Lennep JE. Blood Pressure Profile 1 Year After Severe Preeclampsia. Hypertension 2018; 71:491-498. [PMID: 29437895 DOI: 10.1161/hypertensionaha.117.10338] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [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: 09/18/2017] [Revised: 10/09/2017] [Accepted: 12/07/2017] [Indexed: 11/16/2022]
Abstract
Preeclampsia increases the long-term risk of cardiovascular disease, possibly through occurrence of hypertension after delivery, such as masked hypertension, night-time hypertension, and an adverse systolic night-to-day blood pressure (BP) ratio. These types of hypertension are often unnoticed and can only be detected with ambulatory BP monitoring (ABPM). We aimed to determine hypertension prevalence and 24-hour BP pattern with ABPM and office BP measurements in women 1 year after severe preeclampsia. This is a retrospective cohort study. As part of a follow-up program after severe preeclampsia, 200 women underwent ABPM and an office BP measurement 1 year after delivery. We calculated hypertension prevalence (sustained hypertension, masked hypertension, and white-coat hypertension) and systolic night-to-day BP ratio (dipping pattern). Medical files and questionnaires provided information on preexisting hypertension and antihypertensive treatment. One year after delivery, 41.5% of women had hypertension (sustained hypertension, masked hypertension, or white-coat hypertension) with ABPM. Masked hypertension was most common (17.5%), followed by sustained hypertension (14.5%) and white-coat hypertension (9.5%). With sheer office BP measurement, only 24.0% of women would have been diagnosed hypertensive. Forty-six percent of women had a disadvantageous dipping pattern. Hypertension is common 1 year after experiencing severe preeclampsia. Masked hypertension and white-coat hypertension are risk factors for future cardiovascular disease and can only be diagnosed with ABPM. Therefore, ABPM should be offered to all these women at high risk of developing hypertension and possibly future cardiovascular disease.
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Affiliation(s)
- Laura Benschop
- From the Department of Obstetrics and Gynecology (L.B., J.J.D., V.v.B., E.A.P.S.) and Department of Internal Medicine (J.V., J.E.R.v.L.), Erasmus Medical Center, Rotterdam, The Netherlands.
| | - Johannes J Duvekot
- From the Department of Obstetrics and Gynecology (L.B., J.J.D., V.v.B., E.A.P.S.) and Department of Internal Medicine (J.V., J.E.R.v.L.), Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jorie Versmissen
- From the Department of Obstetrics and Gynecology (L.B., J.J.D., V.v.B., E.A.P.S.) and Department of Internal Medicine (J.V., J.E.R.v.L.), Erasmus Medical Center, Rotterdam, The Netherlands
| | - Valeska van Broekhoven
- From the Department of Obstetrics and Gynecology (L.B., J.J.D., V.v.B., E.A.P.S.) and Department of Internal Medicine (J.V., J.E.R.v.L.), Erasmus Medical Center, Rotterdam, The Netherlands
| | - Eric A P Steegers
- From the Department of Obstetrics and Gynecology (L.B., J.J.D., V.v.B., E.A.P.S.) and Department of Internal Medicine (J.V., J.E.R.v.L.), Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jeanine E Roeters van Lennep
- From the Department of Obstetrics and Gynecology (L.B., J.J.D., V.v.B., E.A.P.S.) and Department of Internal Medicine (J.V., J.E.R.v.L.), Erasmus Medical Center, Rotterdam, The Netherlands
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Berks D, Hoedjes M, Raat H, Franx A, Looman CWN, Van Oostwaard MF, Papatsonis DNM, Duvekot JJ, Steegers EAP. Feasibility and effectiveness of a lifestyle intervention after complicated pregnancies to improve risk factors for future cardiometabolic disease. Pregnancy Hypertens 2018; 15:98-107. [PMID: 30825935 DOI: 10.1016/j.preghy.2018.12.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [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: 11/14/2018] [Accepted: 12/10/2018] [Indexed: 01/05/2023]
Abstract
OBJECTIVES To evaluate the feasibility and effectiveness of a postpartum lifestyle intervention after pregnancies complicated by preeclampsia, fetal growth restriction (FGR) and/or gestational diabetes mellitus (GDM) to improve maternal risk factors for future cardiometabolic disease. METHODS Women following a complicated pregnancy were included six months postpartum in this specific pre-post controlled designed study. It has been conducted in one tertiary and three secondary care hospitals (intervention group) and one secondary care hospital (control group). The program consisted of a computer-tailored health education program combined with three individual counselling sessions during seven months. Primary outcome measures were the proportion of eligible women and weight change during the intervention. RESULTS Two hundred and six women were willing to participate. The proportion of eligible women who complied with the intervention was 23%. Major barrier was lack of time. Adjusted weight change attributed to lifestyle intervention was -1.9 kg (95%-CI -4.3 to -0.3). Further changes were BMI (-0.9 kg/m2 (95%-CI -1.4 to -0.3)), waist-to-hip ratio (-0.04 cm/cm (95%-CI -0.06 to -0.03)), blood pressure medication use (19% (95%-CI 9% to 28%)), HOMA2-score (59 %S (95%-CI 18 to 99)) and total fat intake (-2.9 gr (95%-CI -4.6 to -1.2)). CONCLUSIONS The results support feasibility and effectiveness of a lifestyle intervention after complicated pregnancies to improve maternal cardiometabolic risk factors. Further randomized controlled studies are needed with longer follow-up to evaluate durability. In the meantime, we suggest health care professionals to offer lifestyle interventions to women after complicated pregnancies.
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Affiliation(s)
- D Berks
- Erasmus MC, Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Rotterdam, The Netherlands
| | - M Hoedjes
- Erasmus MC, Department of Public Health, Rotterdam, The Netherlands
| | - H Raat
- Erasmus MC, Department of Public Health, Rotterdam, The Netherlands
| | - A Franx
- University Medical Centre Utrecht, Division Woman and Baby, Utrecht, The Netherlands
| | - C W N Looman
- Erasmus MC, Department of Public Health, Rotterdam, The Netherlands
| | - M F Van Oostwaard
- Erasmus MC, Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Rotterdam, The Netherlands
| | - D N M Papatsonis
- Amphia Hospital, Department of Obstetrics and Gynaecology, Breda, The Netherlands
| | - J J Duvekot
- Erasmus MC, Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Rotterdam, The Netherlands.
| | - E A P Steegers
- Erasmus MC, Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Rotterdam, The Netherlands
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Rijckborst V, Hoekstra J, Claessen MMH, Duvekot JJ, de Man RA. [Pregnancy and lever cirrhosis: a high-risk combination]. Ned Tijdschr Geneeskd 2018; 162:D2457. [PMID: 30379499] [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: 06/08/2023]
Abstract
BACKGROUND Pregnancy rarely occurs in women with liver cirrhosis. However, for those who do become pregnant there are substantial maternal and foetal risks. CASE DESCRIPTION A 29-year-old pregnant woman with fully compensated liver cirrhosis was referred to a tertiary centre. No oesophageal or stomach varices were identified, nor indications for decompensation of the liver disease. Following an uneventful pregnancy, she gave (vaginal) birth at term to a healthy son. CONCLUSION The risk of complications in pregnant patients with liver cirrhosis is related to the degree of liver dysfunction and the presence of portal hypertension, emphasizing the importance of individualised preconception counselling. Oesophageal or stomach variceal bleeding during pregnancy carries a considerable risk of mortality. Therefore, screening endoscopy in the second trimester is advised to facilitate primary prophylaxis of variceal bleeding. Although the risk of variceal bleeding is increased during delivery, elective caesarean sections are not routinely performed because of an increased risk of bleeding due to abdominal wall varices. Pregnant women with liver cirrhosis should ideally be managed in a tertiary centre and in a multidisciplinary setting, to include input from a gynaecologist and gastroenterologist/hepatologist.
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Affiliation(s)
| | | | | | | | - Robert A de Man
- Erasmus MC, afd. Maag-, Darm- en Leverziekten, Rotterdam
- Contact: R.A. de Man
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Saleh L, van den Meiracker AH, Geensen R, Kaya A, Roeters van Lennep JE, Duvekot JJ, Verdonk K, Steegers EAP, Russcher H, Danser AHJ, Visser W. Soluble fms-like tyrosine kinase-1 and placental growth factor kinetics during and after pregnancy in women with suspected or confirmed pre-eclampsia. Ultrasound Obstet Gynecol 2018; 51:751-757. [PMID: 28600845 DOI: 10.1002/uog.17547] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Revised: 04/21/2017] [Accepted: 05/26/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To assess the evolution of the soluble fms-like tyrosine kinase-1 (sFlt-1) to placental growth factor (PlGF) ratio in women with suspected or confirmed pre-eclampsia (PE), and to investigate the changes in sFlt-1 and PlGF levels in pre-eclamptic women after delivery. METHODS This was an exploratory study in which secondary analysis was performed on a prospective cohort study that enrolled women with a singleton pregnancy and suspected or confirmed PE from 18 weeks' gestation, carried out between December 2013 and April 2016 at the Department of Obstetrics of the Erasmus Medical Center in Rotterdam. sFlt-1 and PlGF were determined using Roche Diagnostics Elecsys assays in two groups of patients. In the first group, patients with suspected or confirmed PE had sFlt-1 and PlGF levels measured at least twice during their pregnancy. Changes in these biomarkers over the course of pregnancy were compared for patients in this group with a baseline sFlt-1/PlGF ratio of ≤ 38 and for those with a ratio > 38. In the second group, sFlt-1 and PlGF levels of women with PE or HELLP syndrome were measured before and after delivery. For this group, pre- and postpartum sFlt-1 and PlGF levels were compared and half-lives were calculated. RESULTS Women with suspected or confirmed PE for whom sFlt-1 and PlGF levels were measured at least twice during pregnancy (n = 46) had a median gestational age at inclusion of 26 weeks (range, 18-40 weeks). In 27 of the 30 patients with sFlt-1/PlGF ratio ≤ 38 at baseline, thereby ruling out PE, the sFlt-1/PlGF ratio remained stable for up to 100 days. In the remaining three patients with a ratio ≤ 38 and in most of the 16 patients with a ratio > 38, the ratio increased further. For women diagnosed with PE or HELLP syndrome for whom sFlt-1 and PlGF levels were measured before and after delivery (n = 26), median gestational age at inclusion was 29 weeks (range, 16-37 weeks) and median time between antepartum measurement and delivery was 2 days (range, 1-17 days). In this group, after delivery, sFlt-1 dropped to < 1% of its pre-delivery value, with a half-life of 1.4 ± 0.3 days, while PlGF dropped to ∼30% of its pre-delivery value, with a half-life of 3.7 ± 4.3 days. CONCLUSIONS Based on this small cohort, up to 10% of pregnant women admitted with suspected or confirmed PE presenting with a sFlt-1/PlGF ratio of ≤ 38 display a rise in sFlt-1/PlGF ratio in subsequent weeks, implying that repeat determination of the sFlt-1/PlGF ratio is required to exclude definitively a diagnosis of PE. Furthermore, the rapid and pronounced decline in sFlt-1 levels after delivery in patients with PE/HELLP syndrome suggests that sFlt-1, in contrast to PlGF, is almost entirely derived from the placenta. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- L Saleh
- Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - A H van den Meiracker
- Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - R Geensen
- Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - A Kaya
- Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - J E Roeters van Lennep
- Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - J J Duvekot
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - K Verdonk
- Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - E A P Steegers
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - H Russcher
- Department of Clinical Chemistry, Erasmus MC, Rotterdam, The Netherlands
| | - A H J Danser
- Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - W Visser
- Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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van Baaren GJ, Vis JY, Wilms FF, Oudijk MA, Kwee A, Porath MM, Scheepers HCJ, Spaanderman MEA, Bloemenkamp KWM, Haak MC, Bax CJ, Cornette JMJ, Duvekot JJ, Nij Bijvanck BWA, van Eyck J, Franssen MTM, Sollie KM, Vandenbussche FPHA, Woiski M, Bolte AC, van der Post JAM, Bossuyt PMM, Opmeer BC, Mol BWJ. Cost-effectiveness of diagnostic testing strategies including cervical-length measurement and fibronectin testing in women with symptoms of preterm labor. Ultrasound Obstet Gynecol 2018; 51:596-603. [PMID: 28370518 DOI: 10.1002/uog.17481] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Revised: 01/29/2017] [Accepted: 03/22/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To evaluate the cost-effectiveness of combining cervical-length (CL) measurement and fetal fibronectin (fFN) testing in women with symptoms of preterm labor between 24 and 34 weeks' gestation. METHODS This was a model-based cost-effectiveness analysis evaluating seven test-treatment strategies based on CL measurement and/or fFN testing in women with symptoms of preterm labor from a societal perspective, in which neonatal outcomes and costs were weighted. Estimates of disease prevalence, test accuracy and costs were based on two recently performed nationwide cohort studies in The Netherlands. RESULTS Strategies using fFN testing and CL measurement separately to predict preterm delivery are associated with higher costs and incidence of adverse neonatal outcomes compared with strategies that combine both tests. Additional fFN testing when CL is 15-30 mm was considered cost effective, leading to a cost saving of €3919 per woman when compared with a treat-all strategy, with a small deterioration in neonatal health outcomes, namely one additional perinatal death and 21 adverse outcomes per 10 000 women with signs of preterm labor (incremental cost-effectiveness ratios €39 million and €1.9 million, respectively). Implementing this strategy in The Netherlands, a country with about 180 000 deliveries annually, could lead to an annual cost saving of between €2.4 million and €7.6 million, with only a small deterioration in neonatal health outcomes. CONCLUSION In women with symptoms of preterm labor at 24-34 weeks' gestation, performing additional fFN testing when CL is between 15 and 30 mm is a viable and cost-saving strategy. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- G-J van Baaren
- Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, The Netherlands
| | - J Y Vis
- Department of Clinical Chemistry and Hematology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - F F Wilms
- Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven, The Netherlands
| | - M A Oudijk
- Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, The Netherlands
| | - A Kwee
- Department of Obstetrics and Gynecology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M M Porath
- Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven, The Netherlands
| | - H C J Scheepers
- Department of Obstetrics and Gynecology, University Hospital Maastricht, Maastricht, The Netherlands
| | - M E A Spaanderman
- Department of Obstetrics and Gynecology, University Hospital Maastricht, Maastricht, The Netherlands
| | - K W M Bloemenkamp
- Department of Obstetrics and Gynecology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M C Haak
- Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | - C J Bax
- Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, The Netherlands
| | - J M J Cornette
- Department of Obstetrics and Gynecology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - J J Duvekot
- Department of Obstetrics and Gynecology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - B W A Nij Bijvanck
- Department of Obstetrics and Gynecology, Isala Clinics, Zwolle, The Netherlands
| | - J van Eyck
- Department of Obstetrics and Gynecology, Isala Clinics, Zwolle, The Netherlands
| | - M T M Franssen
- Department of Obstetrics and Gynecology, University Medical Center Groningen, Groningen, The Netherlands
| | - K M Sollie
- Department of Obstetrics and Gynecology, University Medical Center Groningen, Groningen, The Netherlands
| | - F P H A Vandenbussche
- Department of Obstetrics and Gynecology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - M Woiski
- Department of Obstetrics and Gynecology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - A C Bolte
- Department of Obstetrics and Gynecology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - J A M van der Post
- Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, The Netherlands
| | - P M M Bossuyt
- Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, Amsterdam, The Netherlands
| | - B C Opmeer
- Clinical Research Unit, Academic Medical Center, Amsterdam, The Netherlands
| | - B W J Mol
- Department of Obstetrics and Gynecology, The Robinson Institute, School of Pediatrics and Reproductive Health, University of Adelaide, Adelaide, Australia
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Hitzerd E, Bogers H, Kianmanesh Rad NA, Duvekot JJ. A viable caesarean scar pregnancy in a woman using a levonorgestrel-releasing intrauterine device: a case report. EUR J CONTRACEP REPR 2018; 23:161-163. [PMID: 29583023 DOI: 10.1080/13625187.2018.1447663] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Although the levonorgestrel-releasing intrauterine device (LNG-IUD) is one of the most reliable methods of contraception, it is associated with an increased risk of ectopic pregnancy in case of unintended pregnancy. A rare form of ectopic pregnancy is the caesarean scar pregnancy (CSP), with a high risk of serious maternal morbidity, such as uterine rupture, massive haemorrhage and resulting infertility. This report describes the first case of a viable CSP at 13 weeks of gestation in association with the use of a LNG-IUD. Case-presentation: A 36-year-old Caucasian woman was referred to our outpatient clinic because of suspicion of a CSP. The pregnancy was unintended and was diagnosed during replacement of the LNG-IUD after five years. The patient had undergone two caesarean sections in the past. Ultrasound investigation showed an intact pregnancy of approximately 13 weeks of gestation located in the uterine scar. Because of the size of the gestational sac, a laparotomy was performed under general anaesthesia using a Joel-Cohen incision. The procedure was complicated by a total blood loss of 1500 mL, mostly caused by diffuse bleeding from the placental bed. CONCLUSION Unintended pregnancies in women using a LNG-IUD are frequently ectopic pregnancies with a preponderance to nidate outside the fallopian tube. Therefore, early diagnosis and location of the pregnancy in women using a LNG-IUD is essential.
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Affiliation(s)
- Emilie Hitzerd
- a Department of Obstetrics and Gynaecology , Erasmus MC University Medical Center , Rotterdam , The Netherlands
| | - Hein Bogers
- a Department of Obstetrics and Gynaecology , Erasmus MC University Medical Center , Rotterdam , The Netherlands
| | - Noush A Kianmanesh Rad
- b Department of Obstetrics and Gynaecology , IJsselland Hospital , Capelle aan den IJssel , The Netherlands
| | - Johannes J Duvekot
- a Department of Obstetrics and Gynaecology , Erasmus MC University Medical Center , Rotterdam , The Netherlands
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42
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Croles FN, Nasserinejad K, Duvekot JJ, Kruip MJ, Meijer K, Leebeek FW. Pregnancy, thrombophilia, and the risk of a first venous thrombosis: systematic review and bayesian meta-analysis. BMJ 2017; 359:j4452. [PMID: 29074563 PMCID: PMC5657463 DOI: 10.1136/bmj.j4452] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Objective To provide evidence to support updated guidelines for the management of pregnant women with hereditary thrombophilia in order to reduce the risk of a first venous thromboembolism (VTE) in pregnancy.Design Systematic review and bayesian meta-analysis.Data sources Embase, Medline, Web of Science, Cochrane Library, and Google Scholar from inception through 14 November 2016.Review methods Observational studies that reported on pregnancies without the use of anticoagulants and the outcome of first VTE for women with thrombophilia were eligible for inclusion. VTE was considered established if it was confirmed by objective means, or when the patient had received a full course of a full dose anticoagulant treatment without objective testing. Results 36 studies were included in the meta-analysis. All thrombophilias increased the risk for pregnancy associated VTE (probabilities ≥91%). Regarding absolute risks of pregnancy associated VTE, high risk thrombophilias were antithrombin deficiency (antepartum: 7.3%, 95% credible interval 1.8% to 15.6%; post partum: 11.1%, 3.7% to 21.0%), protein C deficiency (antepartum: 3.2%, 0.6% to 8.2%; post partum: 5.4%, 0.9% to 13.8%), protein S deficiency (antepartum: 0.9%, 0.0% to 3.7%; post partum: 4.2%; 0.7% to 9.4%), and homozygous factor V Leiden (antepartum: 2.8%, 0.0% to 8.6%; post partum: 2.8%, 0.0% to 8.8%). Absolute combined antepartum and postpartum risks for women with heterozygous factor V Leiden, heterozygous prothrombin G20210A mutations, or compound heterozygous factor V Leiden and prothrombin G20210A mutations were all below 3%. Conclusions Women with antithrombin, protein C, or protein S deficiency or with homozygous factor V Leiden should be considered for antepartum or postpartum thrombosis prophylaxis, or both. Women with heterozygous factor V Leiden, heterozygous prothrombin G20210A mutation, or compound heterozygous factor V Leiden and prothrombin G20210A mutation should generally not be prescribed thrombosis prophylaxis on the basis of thrombophilia and family history alone. These data should be considered in future guidelines on pregnancy associated VTE risk.
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Affiliation(s)
- F Nanne Croles
- Department of Hematology, Erasmus University Medical Centre, Postbus 2040, 3000 CA, Rotterdam, Netherlands
| | - Kazem Nasserinejad
- Department of Hematology, Erasmus University Medical Centre, Postbus 2040, 3000 CA, Rotterdam, Netherlands
| | - Johannes J Duvekot
- Department of Obstetrics and Gynaecology, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - Marieke Jha Kruip
- Department of Hematology, Erasmus University Medical Centre, Postbus 2040, 3000 CA, Rotterdam, Netherlands
| | - Karina Meijer
- Department of Haematology, University Medical Centre, University of Groningen, Groningen, Netherlands
| | - Frank Wg Leebeek
- Department of Hematology, Erasmus University Medical Centre, Postbus 2040, 3000 CA, Rotterdam, Netherlands
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Bilardo CM, Hecher K, Visser GHA, Papageorghiou AT, Marlow N, Thilaganathan B, Van Wassenaer-Leemhuis A, Todros T, Marsal K, Frusca T, Arabin B, Brezinka C, Derks JB, Diemert A, Duvekot JJ, Ferrazzi E, Ganzevoort W, Martinelli P, Ostermayer E, Schlembach D, Valensise H, Thornton J, Wolf H, Lees C. Severe fetal growth restriction at 26-32 weeks: key messages from the TRUFFLE study. Ultrasound Obstet Gynecol 2017; 50:285-290. [PMID: 28938063 DOI: 10.1002/uog.18815] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Indexed: 06/07/2023]
Affiliation(s)
- C M Bilardo
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Vrije Universiteit Medical Center, Amsterdam, The Netherlands
| | - K Hecher
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - G H A Visser
- University Medical Center, Division of Woman and Baby, Utrecht, The Netherlands
| | - A T Papageorghiou
- St George's, University of London and St George's University Hospitals NHS Foundation Trust, Molecular and Clinical Sciences Research Institute, London, UK
| | - N Marlow
- Department of Academic Neonatology, UCL Institute for Women's Health, London, UK
| | - B Thilaganathan
- St George's, University of London and St George's University Hospitals NHS Foundation Trust, Molecular and Clinical Sciences Research Institute, London, UK
| | - A Van Wassenaer-Leemhuis
- Department of Neonatology, Emma Children's Hospital Academic Medical Centre, Amsterdam, The Netherlands
| | - T Todros
- Department of Obstetrics & Gynecology, University of Turin, Turin, Italy
| | - K Marsal
- Department of Obstetrics and Gynecology, Lund University, University Hospital, Lund, Sweden
| | - T Frusca
- Maternal-Fetal Medicine Unit, University of Parma, Parma, Italy
| | - B Arabin
- Department of Perinatology, Isala Clinics, Zwolle, The Netherlands
- Center for Mother and Child of the Philipps University, Marburg, Germany
| | - C Brezinka
- Department of Obstetrics and Gynecology, Medical University Innsbruck, Innsbruck, Austria
| | - J B Derks
- Perinatal Center, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - A Diemert
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - J J Duvekot
- Division of Obstetrics and Prenatal Medicine, Department of Obstetrics and Gynaecology, Erasmus MC, Rotterdam, The Netherlands
| | - E Ferrazzi
- Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - W Ganzevoort
- Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands
| | - P Martinelli
- Department of Gynecology and Obstetrics, University Federico II of Naples, Naples, Italy
| | - E Ostermayer
- Section of Perinatal Medicine, Department of Obstetrics and Gynecology, Technical University, Munich, Germany
| | - D Schlembach
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | - H Valensise
- Department of Biomedicine, Tor Vergata University, Policlinico Casilino, Rome, Italy
| | - J Thornton
- Department of Obstetrics and Gynaecology, City Hospital, Nottingham, UK
| | - H Wolf
- Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands
| | - C Lees
- Department of Surgery and Cancer, Imperial College London, London, UK
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
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44
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van Eerden L, de Groot CJM, Zeeman GG, Page-Christiaens GCM, Pajkrt E, Duvekot JJ, Vandenbussche FP, Oei SG, Scheepers HCJ, van Eyck J, Middeldorp JM, Bolte AC. Subsequent pregnancy outcome after mid-trimester termination of pregnancy for preeclampsia. Aust N Z J Obstet Gynaecol 2017; 58:204-209. [PMID: 28850666 DOI: 10.1111/ajo.12691] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 05/18/2017] [Accepted: 07/24/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND In this study we determined the outcome of subsequent pregnancies after termination of pregnancy for preeclampsia, with the purpose of presenting data useful for counselling these women on future pregnancies. STUDY DESIGN The cohort consisted of 131 women with a history of termination of pregnancy for preeclampsia. RESULTS Data of 79 pregnancies were available for analysis, including 13 women with chronic hypertension and 16 women with thrombophilia. There were seven miscarriages (8.8%) and 72 ongoing pregnancies. Low-dose aspirin was prescribed for 64 women (89%). The mean gestational age at delivery was 356/7 ± 4 weeks with a mean birth weight of 2571 ± 938 g. Overall recurrence rate for preeclampsia was 29% at a mean gestational age of 32 weeks. Thirty-eight women had an uncomplicated pregnancy (53%). The women with chronic hypertension had the highest recurrence rate of 38%. Neonatal mortality was 4%. CONCLUSION The course of subsequent pregnancies after mid-trimester termination for preeclampsia is uncomplicated in 53% with a recurrence rate for preeclampsia of 29%. The mean gestational age at delivery was 11 weeks later and birth weight 2000 g higher than in the index pregnancy.
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Affiliation(s)
- Leonoor van Eerden
- Department of Obstetrics and Gynecology, VU Medical Center, Amsterdam, The Netherlands
| | | | - Gerda G Zeeman
- Department of Obstetrics and Gynecology, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Eva Pajkrt
- Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, The Netherlands
| | - Johannes J Duvekot
- Department of Obstetrics and Gynecology, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Frank P Vandenbussche
- Department of Obstetrics and Gynecology, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
| | - Swan G Oei
- Department of Obstetrics and Gynecology, Maxima Medical Center Veldhoven, Veldhoven, The Netherlands
| | - Hubertina C J Scheepers
- Department of Obstetrics and Gynecology, Maastricht Medical Center, Maastricht, The Netherlands
| | - Jim van Eyck
- Department of Obstetrics and Gynecology, Isala Zwolle, Zwolle, The Netherlands
| | - Johanna M Middeldorp
- Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, The Netherlands
| | - Antoinette C Bolte
- Department of Obstetrics and Gynecology, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
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45
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Wolf H, Arabin B, Lees CC, Oepkes D, Prefumo F, Thilaganathan B, Todros T, Visser GHA, Bilardo CM, Derks JB, Diemert A, Duvekot JJ, Ferrazzi E, Frusca T, Hecher K, Marlow N, Martinelli P, Ostermayer E, Papageorghiou AT, Scheepers HCJ, Schlembach D, Schneider KTM, Valcamonico A, van Wassenaer-Leemhuis A, Ganzevoort W. Longitudinal study of computerized cardiotocography in early fetal growth restriction. Ultrasound Obstet Gynecol 2017; 50:71-78. [PMID: 27484356 DOI: 10.1002/uog.17215] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 07/03/2016] [Accepted: 07/08/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To explore whether, in early fetal growth restriction (FGR), the longitudinal pattern of fetal heart rate (FHR) short-term variation (STV) can be used to identify imminent fetal distress and whether abnormalities of FHR recordings are associated with 2-year infant outcome. METHODS The original TRUFFLE study assessed whether, in early FGR, delivery based on ductus venosus (DV) Doppler pulsatility index (PI), in combination with safety-net criteria of very low STV on cardiotocography (CTG) and/or recurrent FHR decelerations, could improve 2-year infant survival without neurological impairment in comparison with delivery based on CTG monitoring only. This was a secondary analysis of women who delivered before 32 weeks and had consecutive STV data recorded > 3 days before delivery and known infant outcome at 2 years of age. Women who received corticosteroids within 3 days of delivery were excluded. Individual regression line algorithms of all STV values, except the last one before delivery, were calculated. Life tables and Cox regression analysis were used to calculate the daily risk for low STV or very low STV and/or FHR decelerations (below DV group safety-net criteria) and to assess which parameters were associated with this risk. Furthermore, it was assessed whether STV pattern, last STV value or recurrent FHR decelerations were associated with 2-year infant outcome. RESULTS One hundred and forty-nine women from the original TRUFFLE study met the inclusion criteria. Using the individual STV regression lines, prediction of a last STV below the cut-off used by the CTG monitoring group had sensitivity of 42% and specificity of 91%. For each day after study inclusion, the median risk for low STV (CTG group cut-off) was 4% (interquartile range (IQR), 2-7%) and for very low STV and/or recurrent FHR decelerations (below DV group safety-net criteria) was 5% (IQR, 4-7%). Measures of STV pattern, fetal Doppler (arterial or venous), birth-weight multiples of the median and gestational age did not usefully improve daily risk prediction. There was no association of STV regression coefficients, a low last STV and/or recurrent FHR decelerations with short- or long-term infant outcomes. CONCLUSION The TRUFFLE study showed that a strategy of DV monitoring with safety-net criteria of very low STV and/or recurrent FHR decelerations for delivery indication could increase 2-year infant survival without neurological impairment. This post-hoc analysis demonstrates that, in early FGR, the daily risk of abnormal CTG, as defined by the DV group safety-net criteria, is 5%, and that prediction is not possible. This supports the rationale for CTG monitoring more often than daily in these high-risk fetuses. Low STV and/or recurrent FHR decelerations were not associated with adverse infant outcome and it appears safe to delay intervention until such abnormalities occur, as long as DV-PI is within normal range. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- H Wolf
- Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands
| | - B Arabin
- Center for Mother and Child of the Phillips University, Marburg, Germany
| | - C C Lees
- Department of Surgery and Cancer, Imperial College London, London, UK
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - D Oepkes
- Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | - F Prefumo
- Maternal-Fetal Medicine Unit, University of Brescia, Brescia, Italy
| | - B Thilaganathan
- Fetal Medicine Unit, St George's, University of London and St George's University Hospitals NHS Foundation Trust, Molecular and Clinical Sciences Research Institute, London, UK
| | - T Todros
- Department of Obstetrics and Gynaecology, University of Turin, Turin, Italy
| | - G H A Visser
- Department of Perinatal Medicine, University Medical Center, Utrecht, The Netherlands
| | - C M Bilardo
- Department of Obstetrics and Gynaecology, University Medical Center, University of Groningen, Groningen, The Netherlands
| | - J B Derks
- Department of Perinatal Medicine, University Medical Center, Utrecht, The Netherlands
| | - A Diemert
- Department of Obstetrics and Fetal Medicine, University Medical Center, Hamburg, Eppendorf, Germany
| | - J J Duvekot
- Department of Obstetrics and Gynaecology, Erasmus MC, Rotterdam, The Netherlands
| | - E Ferrazzi
- Department of Woman, Mother and Neonate, Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - T Frusca
- Department of Obstetrics and Gynecology, Maggiore Hospital, University of Parma, Parma, Italy
| | - K Hecher
- Department of Obstetrics and Fetal Medicine, University Medical Center, Hamburg, Eppendorf, Germany
| | - N Marlow
- Department of Neonatology, Institute for Women's Health, University College Hospitals London, London, UK
| | - P Martinelli
- Department of Neuroscience, Dentistry and Reproductive Sciences, University of Naples Federico II, Naples, Italy
| | - E Ostermayer
- Division of Perinatal Medicine, Department of Obstetrics and Gynecology, Technical University, Munich, Germany
| | - A T Papageorghiou
- Fetal Medicine Unit, St George's, University of London and St George's University Hospitals NHS Foundation Trust, Molecular and Clinical Sciences Research Institute, London, UK
| | - H C J Scheepers
- Department of Obstetrics, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - D Schlembach
- Department of Obstetrics, Vivantes Clinic Neukölln, Berlin, Germany
| | - K T M Schneider
- Division of Perinatal Medicine, Department of Obstetrics and Gynecology, Technical University, Munich, Germany
| | - A Valcamonico
- Maternal-Fetal Medicine Unit, University of Brescia, Brescia, Italy
| | - A van Wassenaer-Leemhuis
- Department of Neonatology, Emma Children's Hospital Academic Medical Centre, Amsterdam, The Netherlands
| | - W Ganzevoort
- Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands
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46
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Ganzevoort W, Mensing Van Charante N, Thilaganathan B, Prefumo F, Arabin B, Bilardo CM, Brezinka C, Derks JB, Diemert A, Duvekot JJ, Ferrazzi E, Frusca T, Hecher K, Marlow N, Martinelli P, Ostermayer E, Papageorghiou AT, Schlembach D, Schneider KTM, Todros T, Valcamonico A, Visser GHA, Van Wassenaer-Leemhuis A, Lees CC, Wolf H. How to monitor pregnancies complicated by fetal growth restriction and delivery before 32 weeks: post-hoc analysis of TRUFFLE study. Ultrasound Obstet Gynecol 2017; 49:769-777. [PMID: 28182335 DOI: 10.1002/uog.17433] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Revised: 01/22/2017] [Accepted: 01/23/2017] [Indexed: 06/06/2023]
Abstract
OBJECTIVES In the recent TRUFFLE study, it appeared that, in pregnancies complicated by fetal growth restriction (FGR) between 26 and 32 weeks' gestation, monitoring of the fetal ductus venosus (DV) waveform combined with computed cardiotocography (CTG) to determine timing of delivery increased the chance of infant survival without neurological impairment. However, concerns with the interpretation were raised, as DV monitoring appeared to be associated with a non-significant increase in fetal death, and some infants were delivered after 32 weeks, at which time the study protocol no longer applied. This secondary sensitivity analysis of the TRUFFLE study focuses on women who delivered before 32 completed weeks' gestation and analyzes in detail the cases of fetal death. METHODS Monitoring data of 317 pregnancies with FGR that delivered before 32 weeks were analyzed, excluding those with absent outcome data or inevitable perinatal death. Women were allocated randomly to one of three groups of indication for delivery according to the following monitoring strategies: (1) reduced fetal heart rate short-term variation (STV) on CTG; (2) early changes in fetal DV waveform; and (3) late changes in fetal DV waveform. Primary outcome was 2-year survival without neurological impairment. The association of the last monitoring data before delivery and infant outcome was assessed by multivariable analysis. RESULTS Two-year survival without neurological impairment occurred more often in the two DV groups (both 83%) than in the CTG-STV group (77%), however, the difference was not statistically significant (P = 0.21). Among the surviving infants in the DV groups, 93% were free of neurological impairment vs 85% of surviving infants in the CTG-STV group (P = 0.049). All fetal deaths (n = 7) occurred in the groups with DV monitoring. Of the monitoring parameters obtained shortly before fetal death in these seven cases, an abnormal CTG was observed in only one case. Multivariable regression analysis of factors at study entry demonstrated that a later gestational age, higher estimated fetal weight-to-50th percentile ratio and lower umbilical artery pulsatility index (PI)/fetal middle cerebral artery-PI ratio were significantly associated with normal outcome. Allocation to DV monitoring had a smaller effect on outcome, but remained in the model (P < 0.1). Abnormal fetal arterial Doppler before delivery was significantly associated with adverse outcome in the CTG-STV group. In contrast, abnormal DV flow was the only monitoring parameter associated with adverse outcome in the DV groups, while fetal arterial Doppler, STV below the cut-off used in the CTG-STV group and recurrent decelerations in fetal heart rate were not. CONCLUSIONS In accordance with the findings of the TRUFFLE study on monitoring and intervention management of very preterm FGR, we found that the proportion of infants surviving without neuroimpairment was not significantly different when the decision for delivery was based on changes in DV waveform vs reduced STV on CTG. The uneven distribution of fetal deaths towards the DV groups was probably a chance effect, and neurological outcome was better among surviving children in these groups. Before 32 weeks, delaying delivery until abnormalities in DV-PI or STV and/or recurrent decelerations in fetal heat rate occur, as defined by the study protocol, is likely to be safe and possibly benefits long-term outcome. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- W Ganzevoort
- Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands
| | - N Mensing Van Charante
- Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands
| | - B Thilaganathan
- Fetal Medicine Unit, St George's, University of London & St George's University Hospitals NHS Foundation Trust, Molecular and Clinical Sciences Research Institute, London, UK
| | - F Prefumo
- Maternal Fetal Medicine Unit, University of Brescia, Brescia, Italy
| | - B Arabin
- Center for Mother and Child of the Phillips University, Marburg, Germany
| | - C M Bilardo
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, University Medical Centre Groningen, Groningen, The Netherlands
| | - C Brezinka
- Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
| | - J B Derks
- Perinatal Center, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - A Diemert
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - J J Duvekot
- Division of Obstetrics and Prenatal Medicine, Department of Obstetrics and Gynaecology, Erasmus MC, Rotterdam, The Netherlands
| | - E Ferrazzi
- Children's Hospital, Buzzi, University of Milan, Milan, Italy
| | - T Frusca
- Department of Obstetrics and Gynecology, Maggiore Hospital, University of Parma, Parma, Italy
| | - K Hecher
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - N Marlow
- University College London Institute for Women's Health Ringgold Standard Institution - Neonatology, London, UK
| | - P Martinelli
- Department of Gynecology and Obstetrics, University Federico II of Naples, Naples, Italy
| | - E Ostermayer
- Section of Perinatal Medicine, Department of Obstetrics and Gynecology, Technical University, Munich, Germany
| | - A T Papageorghiou
- Fetal Medicine Unit, St George's, University of London & St George's University Hospitals NHS Foundation Trust, Molecular and Clinical Sciences Research Institute, London, UK
| | - D Schlembach
- Department of Obstetrics, Vivantes Clinic Neukölln, Berlin, Germany
| | - K T M Schneider
- Section of Perinatal Medicine, Department of Obstetrics and Gynecology, Technical University, Munich, Germany
| | - T Todros
- Department of Obstetrics and Gynecology, University of Turin, Turin, Italy
| | - A Valcamonico
- Department of Obstetrics and Gynecology, Maggiore Hospital, University of Parma, Parma, Italy
| | - G H A Visser
- Perinatal Center, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - A Van Wassenaer-Leemhuis
- Department of Neonatology, Emma Children's Hospital Academic Medical Centre, Amsterdam, The Netherlands
| | - C C Lees
- Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - H Wolf
- Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands
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47
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Desborough MJR, Colman KS, Prick BW, Duvekot JJ, Sweeney C, Odutayo A, Jairath V, Doree C, Trivella M, Hopewell S, Estcourt LJ, Stanworth SJ. Effect of restrictive versus liberal red cell transfusion strategies on haemostasis: systematic review and meta-analysis. Thromb Haemost 2017; 117:889-898. [PMID: 28251234 DOI: 10.1160/th17-01-0015] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 02/02/2017] [Indexed: 01/28/2023]
Abstract
Red cells play a key role in normal haemostasis in vitro but their importance clinically is less clear. The objective of this meta-analysis was to assess if correction of anaemia by transfusing red cells at a high haemoglobin threshold (liberal transfusion) is superior to transfusion at a lower haemoglobin threshold (restrictive transfusion) for reducing the risk of bleeding or thrombotic events. We searched for randomised controlled trials in any clinical setting that compared two red cell transfusion thresholds and investigated the risk of bleeding. We searched for studies published up to October 19, 2016 in The Cochrane Central Register of Controlled Trials, MEDLINE, PubMed, Embase, and the Transfusion Evidence Library and ISI Web of Science. Relative risks (RR) or Peto Odds Ratios (pOR) were pooled using a random-effect model. Nineteen randomised trials with 9852 participants were eligible for inclusion in this review. Overall there was no difference in the risk of any bleeding between transfusion strategies (RR 0.91, 95 % confidence interval [CI] 0.74 to 1.12). The risk of severe or life-threatening bleeding was lower with a restrictive strategy (RR 0.75, 95 % CI 0.57 to 0.99). There was no difference in the risk of thrombotic events (RR 0.83, 95 % CI 0.61 to 1.13). The risk of any bleeding was not reduced with liberal transfusion and there was no overall difference in the risk of thrombotic events. Data from the included trials do not support aiming for a high haemoglobin threshold to improve haemostasis. PROSPERO registration number CRD42016035519.
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Affiliation(s)
- Michael J R Desborough
- Dr. Michael J. R. Desborough, MRCP FRCPath, NHS Blood and Transplant, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK, Tel.: +44 1865 447900, Fax: +44 1865 387957, E-mail:
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48
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van Hagen IM, Duijnhouwer AL, Ten Kate-Booij MJ, Dykgraaf RHM, Duvekot JJ, Utens EMWJ, Roos-Hesselink JW. Wish to conceive and concerns to develop cardiovascular complications during pregnancy in patients with Turner syndrome. J Psychosom Obstet Gynaecol 2017; 38:45-52. [PMID: 27584042 DOI: 10.1080/0167482x.2016.1216961] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Turner syndrome (TS) is associated with subfertility and infertility. Nevertheless, an increasing number of women become pregnant through oocyte donation. The wish to conceive may be negatively influenced by the fear of cardiovascular complications. The aim was to investigate the wish to conceive and the concerns about cardiovascular complications during pregnancy in women with TS. METHODS The patient association for TS invited all members of ≥18 years old (n = 344) to complete a specifically developed, disease-specific questionnaire, including questions about fertility, wish to conceive, attempts and concerns. Results were compared with previously published results of this questionnaire in women with congenital heart disease. RESULTS The questionnaire was completed by 89 women (median age 30.1 years, Q1-Q3 = 22.9-39.4). Of them, 51% had 45, X0-monosomy and 38% had ≥1 cardiac abnormality. Seventeen women (19%) had attempted to become pregnant and 12 of them succeeded to become pregnant. Women who had not undertaken attempts to conceive (81%), considered themselves mainly too young or had no partner. Of the total sample, 58% were concerned about the influence of pregnancy on their cardiovascular status. This was higher (75%) in the sample of women with TS and cardiac abnormalities, than in women with congenital heart disease from a previously published cohort (21%), (p < .001). There were no differences in concerns about pregnancy complications between women with TS who respectively had or had not attempted to become pregnant. DISCUSSION Women with TS, especially those with cardiac abnormalities, show serious concerns about the risks pregnancy may have. Patients should be timely counseled and specifically asked about their concerns. Psychosocial care should be provided when necessary.
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Affiliation(s)
- Iris M van Hagen
- a Department of Cardiology , Erasmus University Medical Center , Rotterdam , The Netherlands
| | - Anthonie L Duijnhouwer
- b Department of Cardiology , Radboud University Medical Center , Nijmegen , The Netherlands
| | - Marianne J Ten Kate-Booij
- c Department of Obstetrics and gynaecology , Erasmus University Medical Center , Rotterdam , The Netherlands
| | - Ramon H M Dykgraaf
- c Department of Obstetrics and gynaecology , Erasmus University Medical Center , Rotterdam , The Netherlands
| | - Johannes J Duvekot
- c Department of Obstetrics and gynaecology , Erasmus University Medical Center , Rotterdam , The Netherlands
| | - Elisabeth M W J Utens
- d Department of Child and Adolescent Psychiatry/Psychology , Erasmus University Medical Center, Sophia Children's Hospital , Rotterdam , The Netherlands
| | - Jolien W Roos-Hesselink
- a Department of Cardiology , Erasmus University Medical Center , Rotterdam , The Netherlands
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49
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van der Louw EJ, Williams TJ, Henry-Barron BJ, Olieman JF, Duvekot JJ, Vermeulen MJ, Bannink N, Williams M, Neuteboom RF, Kossoff EH, Catsman-Berrevoets CE, Cervenka MC. Ketogenic diet therapy for epilepsy during pregnancy: A case series. Seizure 2017; 45:198-201. [DOI: 10.1016/j.seizure.2016.12.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 12/20/2016] [Indexed: 10/20/2022] Open
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50
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Bruijn MMC, Hermans FJR, Vis JY, Wilms FF, Oudijk MA, Kwee A, Porath MM, Oei G, Scheepers HCJ, Spaanderman MEA, Bloemenkamp KWM, Haak MC, Bolte AC, Vandenbussche FPHA, Woiski MD, Bax CJ, Cornette JMJ, Duvekot JJ, Bijvank BWANIJ, van Eyck J, Franssen MTM, Sollie KM, van der Post JAM, Bossuyt PMM, Kok M, Mol BWJ, van Baaren GJ. Which Factors Contribute to False-Positive, False-Negative, and Invalid Results in Fetal Fibronectin Testing in Women with Symptoms of Preterm Labor? Am J Perinatol 2017; 34:234-239. [PMID: 27441567 DOI: 10.1055/s-0036-1585466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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] [Indexed: 10/21/2022]
Abstract
Objective We assessed the influence of external factors on false-positive, false-negative, and invalid fibronectin results in the prediction of spontaneous delivery within 7 days. Methods We studied symptomatic women between 24 and 34 weeks' gestational age. We performed uni- and multivariable logistic regression to estimate the effect of external factors (vaginal soap, digital examination, transvaginal sonography, sexual intercourse, vaginal bleeding) on the risk of false-positive, false-negative, and invalid results, using spontaneous delivery within 7 days as the outcome. Results Out of 708 women, 237 (33%) had a false-positive result; none of the factors showed a significant association. Vaginal bleeding increased the proportion of positive fetal fibronectin (fFN) results, but was significantly associated with a lower risk of false-positive test results (odds ratio [OR], 0.22; 95% confidence intervals [CI], 0.12-0.39). Ten women (1%) had a false-negative result. None of the investigated factors was significantly associated with a significantly higher risk of false-negative results. Twenty-one tests (3%) were invalid; only vaginal bleeding showed a significant association (OR, 4.5; 95% CI, 1.7-12). Conclusion The effect of external factors on the performance of qualitative fFN testing is limited, with vaginal bleeding as the only factor that reduces its validity.
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Affiliation(s)
- Merel M C Bruijn
- Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands
| | - Frederik J R Hermans
- Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands
| | - Jolande Y Vis
- Department of Clinical Chemistry and Hematology, University Medical Centre Utrecht, The Netherlands
| | - Femke F Wilms
- Department of Obstetrics and Gynecology, Catharina Hospital, Eindhoven, The Netherlands
| | - Martijn A Oudijk
- Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands
| | - Anneke Kwee
- Department of Obstetrics and Gynecology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Martina M Porath
- Department of Obstetrics and Gynecology, Máxima Medical Centre, Veldhoven, The Netherlands
| | - Guid Oei
- Department of Obstetrics and Gynecology, Máxima Medical Centre, Veldhoven, The Netherlands
| | - Hubertina C J Scheepers
- Department of Obstetrics and Gynecology, University Hospital Maastricht, Maastricht, The Netherlands
| | - Marc E A Spaanderman
- Department of Obstetrics and Gynecology, University Hospital Maastricht, Maastricht, The Netherlands
| | | | - Monique C Haak
- Department of Obstetrics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Antoinette C Bolte
- Department of Obstetrics and Gynecology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Frank P H A Vandenbussche
- Department of Obstetrics and Gynecology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Mallory D Woiski
- Department of Obstetrics and Gynecology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Caroline J Bax
- Department of Obstetrics and Gynecology, VU University Medical Centre, Amsterdam, The Netherlands
| | - Jérôme M J Cornette
- Department of Obstetrics and Gynecology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Johannes J Duvekot
- Department of Obstetrics and Gynecology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | | | - Jim van Eyck
- Department of Obstetrics and Gynecology, Isala Clinics, Zwolle, The Netherlands
| | - Maureen T M Franssen
- Department of Obstetrics and Gynecology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Krystyna M Sollie
- Department of Obstetrics and Gynecology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Joris A M van der Post
- Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands
| | - Patrick M M Bossuyt
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Centre, Amsterdam, The Netherlands
| | - Marjolein Kok
- Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands
| | - Ben W J Mol
- The Robinson Research Institute School of Medicine, University of Adelaide and The South Australian Health and Medical Research Institute Adelaide Australia, Adelaide, SA, Australia
| | - Gert-Jan van Baaren
- Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands
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