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Rennert KN, Breuking SH, Schuit E, Bekker MN, Woiski M, de Boer MA, Sueters M, Scheepers HCJ, Franssen MTM, Pajkrt E, Mol BWJ, Kok M, Hermans FJR. Change in cervical length after arrested preterm labor and risk of preterm birth. Ultrasound Obstet Gynecol 2021; 58:750-756. [PMID: 33860985 PMCID: PMC8596619 DOI: 10.1002/uog.23653] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/09/2021] [Accepted: 03/26/2021] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To assess the association between preterm birth and cervical length after arrested preterm labor in high-risk pregnant women. METHODS In this post-hoc analysis of a randomized clinical trial, transvaginal cervical length was measured in women whose contractions had ceased 48 h after admission for threatened preterm labor. At admission, women were defined as having a high risk of preterm birth based on a cervical length of < 15 mm or a cervical length of 15-30 mm with a positive fetal fibronectin test. Logistic regression analysis was used to investigate the association of cervical length measured at least 48 h after admission and of the change in cervical length between admission and at least 48 h later, with preterm birth before 34 weeks' gestation and delivery within 7 days after admission. RESULTS A total of 164 women were included in the analysis. Women whose cervical length increased between admission for threatened preterm labor and 48 h later (32%; n = 53) were found to have a lower risk of preterm birth before 34 weeks compared with women whose cervical length did not change (adjusted odds ratio (aOR), 0.24 (95% CI, 0.09-0.69)). The risk in women with a decrease in cervical length between the two timepoints was not different from that in women with no change in cervical length (aOR, 1.45 (95% CI, 0.62-3.41)). Moreover, greater absolute cervical length after 48 h was associated with a lower risk of preterm birth before 34 weeks (aOR, 0.90 (95% CI, 0.84-0.96)) and delivery within 7 days after admission (aOR, 0.91 (95% CI, 0.82-1.02)). Sensitivity analysis in women randomized to receive no intervention showed comparable results. CONCLUSION Our study suggests that the risk of preterm birth before 34 weeks is lower in women whose cervical length increases between admission for threatened preterm labor and at least 48 h later when contractions had ceased compared with women in whom cervical length does not change or decreases. © 2021 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- K. N. Rennert
- Faculty of Medicine, Vrije Universiteit AmsterdamAmsterdamThe Netherlands
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction & Development Research Institute, Amsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - S. H. Breuking
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction & Development Research Institute, Amsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - E. Schuit
- Julius Center for Health Sciences and Primary Care, University Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - M. N. Bekker
- Department of Obstetrics and GynaecologyUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - M. Woiski
- Department of Obstetrics and GynaecologyRadboud University Nijmegen Medical CenterNijmegenThe Netherlands
| | - M. A. de Boer
- Department of Obstetrics and GynaecologyAmsterdam Reproduction & Development Research Institute, Amsterdam UMC, Vrije UniversiteitAmsterdamThe Netherlands
| | - M. Sueters
- Department of Obstetrics and GynaecologyLeiden University Medical CenterLeidenThe Netherlands
| | - H. C. J. Scheepers
- Department of Obstetrics and GynaecologyMaastricht University Medical CenterMaastrichtThe Netherlands
| | - M. T. M. Franssen
- Department of ObstetricsUniversity Medical Center GroningenGroningenThe Netherlands
| | - E. Pajkrt
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction & Development Research Institute, Amsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - B. W. J. Mol
- Department of Obstetrics and Gynaecology, School of MedicineMonash UniversityMelbourneVictoriaAustralia
- Aberdeen Centre for Women's Health ResearchUniversity of AberdeenAberdeenUK
| | - M. Kok
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction & Development Research Institute, Amsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - F. J. R. Hermans
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction & Development Research Institute, Amsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
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2
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de Vaan MDT, Blel D, Bloemenkamp KWM, Jozwiak M, ten Eikelder MLG, de Leeuw JW, Oudijk MA, Bakker JJH, Rijnders RJP, Papatsonis DN, Woiski M, Mol BW, de Heus R. Induction of labor with Foley catheter and risk of subsequent preterm birth: follow-up study of two randomized controlled trials (PROBAAT-1 and -2). Ultrasound Obstet Gynecol 2021; 57:292-297. [PMID: 32939850 PMCID: PMC7898639 DOI: 10.1002/uog.23117] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 08/21/2020] [Accepted: 09/04/2020] [Indexed: 05/04/2023]
Abstract
OBJECTIVE To evaluate the rate of preterm birth (PTB) in a subsequent pregnancy in women who had undergone term induction using a Foley catheter compared with prostaglandins. METHODS This was a follow-up study of two large randomized controlled trials (PROBAAT-1 and PROBAAT-2). In the original trials, women with a term singleton pregnancy with the fetus in cephalic presentation and with an indication for labor induction were randomized to receive either a 30-mL Foley catheter or prostaglandins (vaginal prostaglandin E2 in PROBAAT-1 and oral misoprostol in PROBAAT-2). Data on subsequent ongoing pregnancies > 16 weeks' gestation were collected from hospital charts from clinics participating in this follow-up study. The main outcome measure was preterm birth < 37 weeks' gestation in a subsequent pregnancy. RESULTS Fourteen hospitals agreed to participate in this follow-up study. Of the 1142 eligible women, 572 had been allocated to induction of labor using a Foley catheter and 570 to induction of labor using prostaglandins. Of these, 162 (14%) were lost to follow-up. In total, 251 and 258 women had a known subsequent pregnancy > 16 weeks' gestation in the Foley catheter and prostaglandin groups, respectively. There were no differences in baseline characteristics between the groups. The overall rate of PTB in a subsequent pregnancy was 9/251 (3.6%) in the Foley catheter group vs 10/258 (3.9%) in the prostaglandin group (relative risk (RR), 0.93; 95% CI, 0.38-2.24), and the rate of spontaneous PTB was 5/251 (2.0%) vs 5/258 (1.9%) (RR, 1.03; 95% CI, 0.30-3.51). CONCLUSION In women with term singleton pregnancy, induction of labor using a 30-mL Foley catheter is not associated with an increased risk of PTB in a subsequent pregnancy, as compared to induction of labor using prostaglandins. © 2020 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- M. D. T. de Vaan
- Department of Obstetrics and GynaecologyJeroen Bosch Hospital‘s‐HertogenboschThe Netherlands
- Department of Health Care StudiesRotterdam University of Applied SciencesRotterdamThe Netherlands
| | - D. Blel
- Department of Obstetrics and GynaecologyIkazia HospitalRotterdamThe Netherlands
| | - K. W. M. Bloemenkamp
- Department of Obstetrics, Division Woman and Baby, Wilhelmina Children's Hospital Birth CentreUniversity Medical Centre UtrechtUtrechtThe Netherlands
| | - M. Jozwiak
- Department of Gynaecologic OncologyErasmus Medical CentreRotterdamThe Netherlands
| | - M. L. G. ten Eikelder
- Department of Obstetrics and Gynaecology, Princess Alexandra WingRoyal Cornwall Hospital NHS TrustTruroUK
| | - J. W. de Leeuw
- Department of Obstetrics and GynaecologyIkazia HospitalRotterdamThe Netherlands
| | - M. A. Oudijk
- Department of ObstetricsAmsterdam Reproduction and Development Research Institute, Amsterdam UMC, University of AmsterdamAmsterdamThe Netherlands
| | - J. J. H. Bakker
- Department of ObstetricsAmsterdam Reproduction and Development Research Institute, Amsterdam UMC, University of AmsterdamAmsterdamThe Netherlands
| | - R. J. P. Rijnders
- Department of Obstetrics and GynaecologyJeroen Bosch Hospital‘s‐HertogenboschThe Netherlands
| | - D. N. Papatsonis
- Department of Obstetrics and GynaecologyAmphia HospitalBredaThe Netherlands
| | - M. Woiski
- Department of Obstetrics and GynaecologyRadboud University Medical CentreNijmegenThe Netherlands
| | - B. W. Mol
- Department of Obstetrics and GynaecologyMonash UniversityMelbourneAustralia
- Aberdeen Centre for Women's Health ResearchUniversity of AberdeenAberdeenUK
| | - R. de Heus
- Department of Obstetrics and GynaecologyIkazia HospitalRotterdamThe Netherlands
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3
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de Ruigh AA, Simons NE, van 't Hooft J, van Teeffelen AS, Duijnhoven RG, van Wassenaer-Leemhuis AG, Aarnoudse-Moens C, van de Beek C, Oepkes D, Haak MC, Woiski M, Porath MM, Derks JB, van Kempen L, Roseboom TJ, Mol BW, Pajkrt E. Child outcomes after amnioinfusion compared with no intervention in women with second-trimester rupture of membranes: a long-term follow-up study of the PROMEXIL-III trial. BJOG 2020; 128:292-301. [PMID: 31984652 PMCID: PMC7818451 DOI: 10.1111/1471-0528.16115] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To assess the effect of transabdominal amnioinfusion or no intervention on long-term outcomes in children born after second-trimester prelabour rupture of the membranes (PROM between 16+0/7 -24+0/7 weeks) and oligohydramnios. POPULATION Follow up of infants of women who participated in the randomised controlled trial: PPROMEXIL-III (NTR3492). METHODS Surviving infants were invited for neurodevelopmental assessment up to 5 years of corrected age using a Bayley Scales of Infant and Toddler Development or a Wechsler Preschool and Primary Scale of Intelligence. Parents were asked to complete several questionnaires. MAIN OUTCOME MEASURES Neurodevelopmental outcomes were measured. Mild delay was defined as -1 standard deviation (SD), severe delay as -2 SD. Healthy long-term survival was defined as survival without neurodevelopmental delay or respiratory problems. RESULTS In the amnioinfusion group, 18/28 children (64%) died versus 21/28 (75%) in the no intervention group (relative risk 0.86; 95% confidence interval [CI] 0.60-1.22). Follow-up data were obtained from 14/17 (82%) children (10 amnioinfusion, 4 no intervention). In both groups, 2/28 (7.1%) had a mild neurodevelopmental delay. No severe delay was seen. Healthy long-term survival occurred in 5/28 children (17.9%) after amnioinfusion versus 2/28 (7.1%) after no intervention (odds ratio 2.50; 95% CI 0.53-11.83). When analysing data for all assessed survivors, 10/14 (71.4%) survived without mild neurodevelopmental delay and 7/14 (50%) were classified healthy long-term survivor. CONCLUSIONS In this small sample of women suffering second-trimester PROM and oligohydramnios, amnioinfusion did not improve long-term outcomes. Overall, 71% of survivors had no neurodevelopmental delay. TWEETABLE ABSTRACT Healthy long-term survival was comparable for children born after second-trimester PROM and treatment with amnioinfusion or no intervention.
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Affiliation(s)
- A A de Ruigh
- Department of Obstetrics and Gynaecology, Academic Medical Centre (AMC), Amsterdam, The Netherlands
| | - N E Simons
- Department of Obstetrics and Gynaecology, Academic Medical Centre (AMC), Amsterdam, The Netherlands
| | - J van 't Hooft
- Department of Obstetrics and Gynaecology, Academic Medical Centre (AMC), Amsterdam, The Netherlands
| | - A S van Teeffelen
- Department of Obstetrics and Gynaecology, Grow, School for Oncology and Developmental Biology, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
| | - R G Duijnhoven
- Department of Obstetrics and Gynaecology, Academic Medical Centre (AMC), Amsterdam, The Netherlands
| | - A G van Wassenaer-Leemhuis
- Department of Neonatology, Emma Children's Hospital Academic Medical Centre (AMC), Amsterdam, The Netherlands
| | - C Aarnoudse-Moens
- Department of Neonatology, Emma Children's Hospital Academic Medical Centre (AMC), Amsterdam, The Netherlands
| | - C van de Beek
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction and Development Research Institute, Academic Medical Centre (AMC), Amsterdam, The Netherlands
| | - D Oepkes
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre (LUMC), Leiden, The Netherlands
| | - M C Haak
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre (LUMC), Leiden, The Netherlands
| | - M Woiski
- Department of Obstetrics and Gynaecology, Radboud University Medical Centre (Radboudumc), Nijmegen, The Netherlands
| | - M M Porath
- Department of Obstetrics and Gynaecology, Maxima Medical Centre (MMC), Veldhoven, The Netherlands
| | - J B Derks
- Department of Obstetrics and Gynaecology, University Medical Centre Utrecht (UMCU), Utrecht, The Netherlands
| | - Lem van Kempen
- Department of Obstetrics and Gynaecology, Academic Medical Centre (AMC), Amsterdam, The Netherlands
| | - T J Roseboom
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction and Development Research Institute, Academic Medical Centre (AMC), Amsterdam, The Netherlands
| | - B W Mol
- Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
| | - E Pajkrt
- Department of Obstetrics and Gynaecology, Academic Medical Centre (AMC), Amsterdam, The Netherlands
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4
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Nijman T, van Baaren GJ, van Vliet E, Kok M, Gyselaers W, Porath MM, Woiski M, de Boer MA, Bloemenkamp K, Sueters M, Franx A, Mol B, Oudijk MA. Cost effectiveness of nifedipine compared with atosiban in the treatment of threatened preterm birth (APOSTEL III trial). BJOG 2019; 126:875-883. [PMID: 30666783 DOI: 10.1111/1471-0528.15625] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess the cost-effectiveness of treatment with nifedipine compared with atosiban in women with threatened preterm birth. DESIGN An economic analysis alongside a randomised clinical trial (the APOSTEL III study). SETTING Obstetric departments of 12 tertiary hospitals and seven secondary hospitals in the Netherlands and Belgium. POPULATION Women with threatened preterm birth between 25 and 34 weeks of gestation, randomised for tocolysis with either nifedipine or atosiban. METHODS We performed an economic analysis from a societal perspective. We estimated costs from randomisation until discharge. Analyses for singleton and multiple pregnancies were performed separately. The robustness of our findings was evaluated in sensitivity analyses. MAIN OUTCOME MEASURES Mean costs and differences were calculated per woman treated with nifedipine or atosiban. Health outcomes were expressed as the prevalence of a composite of adverse perinatal outcomes. RESULTS Mean costs per patients were significantly lower in the nifedipine group [singleton pregnancies: €34,897 versus €43,376, mean difference (MD) -€8479 [95% confidence interval (CI) -€14,327 to -€2016)]; multiple pregnancies: €90,248 versus €102,292, MD -€12,044 (95% CI -€21,607 to € -1671). There was a non-significantly higher death rate in the nifedipine group. The difference in costs was mainly driven by a lower neonatal intensive care unit admission (NICU) rate in the nifedipine group. CONCLUSION Treatment with nifedipine in women with threatened preterm birth results in lower costs when compared with treatment with atosiban. However, the safety of nifedipine warrants further investigation. TWEETABLE ABSTRACT In women with threatened preterm birth, tocolysis using nifedipine results in lower costs when compared with atosiban.
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Affiliation(s)
- Taj Nijman
- Birth Centre, Division Woman and Baby, University Medical Centre Utrecht, Utrecht, the Netherlands.,Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, the Netherlands
| | - G J van Baaren
- Department of Obstetrics and Gynecology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Eog van Vliet
- Birth Centre, Division Woman and Baby, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - M Kok
- Department of Obstetrics and Gynecology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - W Gyselaers
- Department of Obstetrics and Gynecology, Ziekenhuis Oost-Limburg, Genk, Belgium.,Department of Physiology, Hasselt University, Diepenbeek, Belgium
| | - M M Porath
- Department of Obstetrics and Gynaecology, Maxima Medical Centre, Veldhoven, the Netherlands
| | - M Woiski
- Department of Obstetrics and Gynaecology, University Medical Centre Nijmegen, Nijmegen, the Netherlands
| | - M A de Boer
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands
| | - Kwm Bloemenkamp
- Birth Centre, Division Woman and Baby, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - M Sueters
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, the Netherlands
| | - A Franx
- Birth Centre, Division Woman and Baby, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Bwj Mol
- Department of Obstetrics and Gynecology, School of Medicine, Monash University, Melbourne, Vic., Australia
| | - M A Oudijk
- Department of Obstetrics and Gynecology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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5
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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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6
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Geurtzen R, Draaisma J, Hermens R, Scheepers H, Woiski M, van Heijst A, Hogeveen M. Prenatal (non)treatment decisions in extreme prematurity: evaluation of Decisional Conflict and Regret among parents. J Perinatol 2017; 37:999-1002. [PMID: 28617426 DOI: 10.1038/jp.2017.90] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 05/01/2017] [Accepted: 05/15/2017] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To evaluate Decisional Conflict and Regret among parents regarding the decision on initiating comfort or active care in extreme prematurity and to relate these to decision-making characteristics. STUDY DESIGN A nationwide, multicenter, cross-sectional study using an online survey in the Netherlands. Data were collected from March 2015 to March 2016 among all parents with infants born at 24+0/7-24+6/7 weeks gestational age in 2010-2013. The survey contained a Decisional Conflict and Decision Regret Scale (potential scores range from 0 to 100) and decision-making characteristics. RESULTS Sixty-one surveys were returned (response rate 27%). The median Decisional Conflict score was 28. From the subscores within Decisional Conflict, 'values clarity' revealed the highest median score of 42-revealing that parents felt unclear about personal values for benefits and risks of the decision on either comfort care or active care. The median Decision Regret score was 0. Regret scores were influenced by the actual decision made and by outcome: Decision Regret was lower in the active care group and in the survivor group. CONCLUSION We found little Decisional Conflict and no Decision Regret among parents regarding decision-making at 24 weeks gestation.
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Affiliation(s)
- R Geurtzen
- Department of Pediatrics, Radboud University Medical Center Amalia Children's Hospital, Nijmegen, The Netherlands
| | - J Draaisma
- Department of Pediatrics, Radboud University Medical Center Amalia Children's Hospital, Nijmegen, The Netherlands
| | - R Hermens
- Scientific Institute for Quality of Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - H Scheepers
- Department of Gynecology, Maastricht UMC+, Maastricht, The Netherlands
| | - M Woiski
- Department of Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - A van Heijst
- Department of Pediatrics, Radboud University Medical Center Amalia Children's Hospital, Nijmegen, The Netherlands
| | - M Hogeveen
- Department of Pediatrics, Radboud University Medical Center Amalia Children's Hospital, Nijmegen, The Netherlands
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7
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Voormolen DN, DeVries J, Kok M, Bekedam D, Brouwer C, Fong B, Binnerts A, Maas R, Potter van Loon B, Lenglet J, Smit N, Heringa M, Sanson R, van Aken M, Porath M, Oosterbaan H, Janssen H, Akerboom B, van Loon A, Hoogenberg K, Woiski M, Naaktgeboren C, Franx A, Mol B, Evers I. 488: Efficacy of continuous glucose monitoring in diabetic pregnancy, the glucomoms trial. Am J Obstet Gynecol 2017. [DOI: 10.1016/j.ajog.2016.11.223] [Citation(s) in RCA: 2] [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: 11/24/2022]
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8
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van de Mheen L, Ravelli AC, Oudijk MA, Bijvank SN, Porath MM, Duvekot JJ, Scholtenhuis MAGHO, Bloemenkamp KWM, Scheepers HCJ, Woiski M, van Pampus MG, Groot CJD, Pajkrt E, Mol BWJ. Prediction of Time to Delivery Week-by-Week in Women with a Triplet Pregnancy. Am J Perinatol 2016; 33:1394-1400. [PMID: 27167642 DOI: 10.1055/s-0036-1583190] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objective Some clinicians advise prophylactic administration of antenatal steroids for fetal lung maturation in women with a triplet pregnancy. However, the effect of corticosteroids is limited to 10 to 14 days after administration. The aim of this study was to assess the natural course of triplet pregnancies to allow a better anticipation for administration of corticosteroids. Study Design We collected data on all triplet pregnancies in the Netherlands from 1999 to 2007 from the Netherlands Perinatal Registration. We calculated time to delivery, the risk of delivery in 2-week intervals at different gestational ages, and the time frame between hospital admission and delivery of the first child. Results Median gestational age at delivery of 494 women with a triplet pregnancy was 33+4 weeks (interquartile range of 31-35+1 weeks). Twenty-one women (4.3%) delivered between 22 and 24 weeks and 146 women (29.6%) delivered before 32 weeks. At a gestational age of 24 weeks, the chance to deliver within the next week was 0.6%. For 26, 28, 30, 31, and 32 weeks, these risks were 2.4, 2.5, 8.1, 7, and 16.7%, respectively. Conclusion Before 32 weeks of gestation, prophylactic administration of steroids is not indicated as the risk to deliver within 7 days is < 10%.
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Affiliation(s)
- L van de Mheen
- Department of Obstetrics and Gynecology, VU University Medical Center, Amsterdam, The Netherlands
| | - A C Ravelli
- Department of Medical Informatics, Academic Medical Center, Amsterdam, The Netherlands
| | - M A Oudijk
- Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, The Netherlands
| | - S Nij Bijvank
- Department of Obstetrics and Gynecology, Isala Clinics, Zwolle, The Netherlands
| | - M M Porath
- Department of Obstetrics and Gynecology, Maxima Medical Center, Veldhoven, The Netherlands
| | - J J Duvekot
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | | | - K W M Bloemenkamp
- Department of Obstetrics and Gynecology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - H C J Scheepers
- Department of Obstetrics and Gynecology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - M Woiski
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - M G van Pampus
- Department of Obstetrics and Gynecology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - C J de Groot
- Department of Obstetrics and Gynecology, VU University Medical Center, Amsterdam, The Netherlands
| | - E Pajkrt
- Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, The Netherlands
| | - B W J Mol
- School of Paediatrics and Reproductive Health, The Robinson Institute, Adelaide, Australia
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9
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Tajik P, Monfrance M, van 't Hooft J, Liem SMS, Schuit E, Bloemenkamp KWM, Duvekot JJ, Nij Bijvank B, Franssen MTM, Oudijk MA, Scheepers HCJ, Sikkema JM, Woiski M, Mol BWJ, Bekedam DJ, Bossuyt PM, Zafarmand MH. A multivariable model to guide the decision for pessary placement to prevent preterm birth in women with a multiple pregnancy: a secondary analysis of the ProTWIN trial. Ultrasound Obstet Gynecol 2016; 48:48-55. [PMID: 26748537 DOI: 10.1002/uog.15855] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 05/25/2015] [Revised: 12/16/2015] [Accepted: 12/23/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE The ProTWIN Trial (NTR1858) showed that, in women with a multiple pregnancy and a cervical length < 25(th) percentile (38 mm), prophylactic use of a cervical pessary reduced the risk of adverse perinatal outcome. We investigated whether other maternal or pregnancy characteristics collected at baseline can improve identification of women most likely to benefit from pessary placement. METHODS ProTWIN is a multicenter randomized trial in which 808 women with a multiple pregnancy were assigned to pessary or control. Using these data we developed a multivariable logistic model comprising treatment, cervical length, chorionicity, pregnancy history and number of fetuses, and the interaction of these variables with treatment as predictors of adverse perinatal outcome. RESULTS Short cervix, monochorionicity and nulliparity were predictive factors for a benefit from pessary insertion. History of previous preterm birth and triplet pregnancy were predictive factors of possible harm from pessary. The model identified 35% of women as benefiting (95% CI, 32-39%), which is 10% more than using cervical length only (25%) for pessary decisions. The model had acceptable calibration. We estimated that using the model to guide the choice of pessary placement would reduce the risk of adverse perinatal outcome significantly from 13.5% when no pessary is inserted to 8.1% (absolute risk reduction, 5.4% (95% CI, 2.1-8.6%)). CONCLUSIONS We developed and internally validated a multivariable treatment selection model, with cervical length, chorionicity, pregnancy history and number of fetuses. If externally validated, it could be used to identify women with a twin pregnancy who would benefit from a pessary, and lead to a reduction in adverse perinatal outcomes in these women. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- P Tajik
- Department of Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, The Netherlands
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Centre, Amsterdam, The Netherlands
| | - M Monfrance
- Department of Obstetrics and Gynaecology, Atrium Medical Centre, Heerlen, The Netherlands
| | - J van 't Hooft
- Department of Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, The Netherlands
| | - S M S Liem
- Department of Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, The Netherlands
| | - E Schuit
- Department of Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, The Netherlands
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - K W M Bloemenkamp
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands
| | - J J Duvekot
- Department of Obstetrics and Gynaecology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - B Nij Bijvank
- Department of Obstetrics and Gynaecology, Isala Clinics, Zwolle, The Netherlands
| | - M T M Franssen
- Department of Obstetrics and Gynaecology, University Medical Centre Groningen, Groningen, The Netherlands
| | - M A Oudijk
- Department of Obstetrics and Gynaecology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - H C J Scheepers
- Department of Obstetrics and Gynaecology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - J M Sikkema
- Department of Obstetrics and Gynaecology, ZGT, Almelo, The Netherlands
| | - M Woiski
- Department of Obstetrics and Gynaecology, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - B W J Mol
- The Robinson Institute, School of Paediatrics and Reproductive Health, University of Adelaide, Adelaide, Australia
| | - D J Bekedam
- Department of Obstetrics and Gynaecology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - P M Bossuyt
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Centre, Amsterdam, The Netherlands
| | - M H Zafarmand
- Department of Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, The Netherlands
- Department of Public Health, Academic Medical Centre, Amsterdam, The Netherlands
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10
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Tajik P, van der Ham D, Zafarmand M, Hof M, Morris J, Franssen M, de Groot C, Duvekot J, Oudijk M, Willekes C, Bloemenkamp K, Porath M, Woiski M, Akerboom B, Sikkema J, Nij Bijvank B, Mulder A, Bossuyt P, Mol B. Using Vaginal Group B Streptococcus Colonization in Women With Preterm Premature Rupture of Membranes to Guide the Decision for Immediate Delivery. ACTA ACUST UNITED AC 2015. [DOI: 10.1097/01.aoa.0000472737.09801.45] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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11
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Tajik P, van der Ham DP, Zafarmand MH, Hof MHP, Morris J, Franssen MTM, de Groot CJM, Duvekot JJ, Oudijk MA, Willekes C, Bloemenkamp KWM, Porath M, Woiski M, Akerboom BM, Sikkema JM, Bijvank BN, Mulder ALM, Bossuyt PM, Mol BWJ. Using vaginal Group B Streptococcuscolonisation in women with preterm premature rupture of membranes to guide the decision for immediate delivery: a secondary analysis of the PPROMEXIL trials. BJOG 2014; 121:1263-72; discussion 1273. [DOI: 10.1111/1471-0528.12889] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2014] [Indexed: 12/01/2022]
Affiliation(s)
- P Tajik
- Department of Obstetrics & Gynaecology; Academic Medical Centre; Amsterdam the Netherlands
- Department of Epidemiology, Biostatistics & Bioinformatics; Academic Medical Centre; Amsterdam the Netherlands
| | - DP van der Ham
- Department of Obstetrics and Gynaecology; GROW - School for Oncology and Developmental Biology; Maastricht University Medical Centre; Maastricht the Netherlands
- Department of Obstetrics & Gynaecology; Martini Hospital; Groningen the Netherlands
| | - MH Zafarmand
- Department of Obstetrics & Gynaecology; Academic Medical Centre; Amsterdam the Netherlands
- Department of Public Health; Academic Medical Centre; Amsterdam the Netherlands
| | - MHP Hof
- Department of Epidemiology, Biostatistics & Bioinformatics; Academic Medical Centre; Amsterdam the Netherlands
| | - J Morris
- Clinical & Population Perinatal Health Research; Kolling Institute of Medical Research; University of Sydney; Sydney NSW Australia
| | - MTM Franssen
- Department of Obstetrics & Gynaecology; University Medical Centre Groningen; Groningen the Netherlands
| | - CJM de Groot
- Department of Obstetrics & Gynaecology; VU University Medical Centre; Amsterdam the Netherlands
| | - JJ Duvekot
- Department of Obstetrics & Gynaecology; Erasmus Medical Centre; Rotterdam the Netherlands
| | - MA Oudijk
- Department of Obstetrics & Gynaecology; University Medical Centre Utrecht; Utrecht the Netherlands
| | - C Willekes
- Department of Obstetrics and Gynaecology; GROW - School for Oncology and Developmental Biology; Maastricht University Medical Centre; Maastricht the Netherlands
| | - KWM Bloemenkamp
- Department of Obstetrics & Gynaecology; Leiden University Medical Centre; Leiden the Netherlands
| | - M Porath
- Department of Obstetrics & Gynaecology; Máxima Medical Centre; Veldhoven the Netherlands
| | - M Woiski
- Department of Obstetrics & Gynaecology; Radboud University Nijmegen; Nijmegen the Netherlands
| | - BM Akerboom
- Department of Obstetrics & Gynaecology; Albert Schweitzer Hospital; Dordrecht the Netherlands
| | - JM Sikkema
- Department of Obstetrics & Gynaecology; ZGT; Almelo the Netherlands
| | - B Nij Bijvank
- Department of Obstetrics & Gynaecology; Isala Clinics; Zwolle the Netherlands
| | - ALM Mulder
- Department of Paediatrics; Maastricht University Medical Centre; Maastricht the Netherlands
| | - PM Bossuyt
- Department of Epidemiology, Biostatistics & Bioinformatics; Academic Medical Centre; Amsterdam the Netherlands
| | - BWJ Mol
- The Robinson Institute; School of Paediatrics and Reproductive Health; University of Adelaide; Adelaide SA Australia
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12
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de Lange N, van Rheenen-Flach L, Lancé M, Mooyman L, Woiski M, van Pampus E, Porath M, Bolte A, Smits L, Henskens Y, Scheepers H. Peri-partum reference ranges for ROTEM ® thromboelastometry. Br J Anaesth 2014; 112:852-9. [DOI: 10.1093/bja/aet480] [Citation(s) in RCA: 96] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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13
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Schoorel ENC, van Kuijk SMJ, Melman S, Nijhuis JG, Smits LJM, Aardenburg R, de Boer K, Delemarre FMC, van Dooren IM, Franssen MTM, Kaplan M, Kleiverda G, Kuppens SMI, Kwee A, Lim FTH, Mol BWJ, Roumen FJME, Sikkema JM, Smid-Koopman E, Visser H, Woiski M, Hermens RPMG, Scheepers HCJ. Vaginal birth after a caesarean section: the development of a Western European population-based prediction model for deliveries at term. BJOG 2014; 121:194-201; discussion 201. [PMID: 24373593 DOI: 10.1111/1471-0528.12539] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2013] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To develop and internally validate a model that predicts the outcome of an intended vaginal birth after caesarean (VBAC) for a Western European population that can be used to personalise counselling for deliveries at term. DESIGN Registration-based retrospective cohort study. SETTING Five university teaching hospitals, seven non-university teaching hospitals, and five non-university non-teaching hospitals in the Netherlands. POPULATION A cohort of 515 women with a history of one caesarean section and a viable singleton pregnancy, without a contraindication for intended VBAC, who delivered at term. METHODS Potential predictors for a vaginal delivery after caesarean section were chosen based on literature and expert opinions. We internally validated the prediction model using bootstrapping techniques. MAIN OUTCOME MEASURES Predictors for VBAC. For model validation, the area under the receiver operating characteristic curve (AUC) for discriminative capacity and calibration-per-risk-quantile for accuracy were calculated. RESULTS A total of 371 out of 515 women had a VBAC (72%). Variables included in the model were: estimated fetal weight greater than the 90(th) percentile in the third trimester; previous non-progressive labour; previous vaginal delivery; induction of labour; pre-pregnancy body mass index; and ethnicity. The AUC was 71% (95% confidence interval, 95% CI = 69-73%), indicating a good discriminative ability. The calibration plot shows that the predicted probabilities are well calibrated, especially from 65% up, which accounts for 77% of the total study population. CONCLUSION We developed an appropriate Western European population-based prediction model that is aimed to personalise counselling for term deliveries.
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Affiliation(s)
- E N C Schoorel
- Department of Obstetrics and Gynaecology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, the Netherlands
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14
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Schoorel ENC, Melman S, van Kuijk SMJ, Grobman WA, Kwee A, Mol BWJ, Nijhuis JG, Smits LJM, Aardenburg R, de Boer K, Delemarre FMC, van Dooren IM, Franssen MTM, Kleiverda G, Kaplan M, Kuppens SMI, Lim FTH, Sikkema JM, Smid-Koopman E, Visser H, Vrouenraets FPJM, Woiski M, Hermens RPMG, Scheepers HCJ. Predicting successful intended vaginal delivery after previous caesarean section: external validation of two predictive models in a Dutch nationwide registration-based cohort with a high intended vaginal delivery rate. BJOG 2014; 121:840-7; discussion 847. [DOI: 10.1111/1471-0528.12605] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2013] [Indexed: 11/27/2022]
Affiliation(s)
- ENC Schoorel
- Department of Obstetrics and Gynaecology of Maastricht University Medical Centre+; GROW-School for Oncology and Developmental Biology; Maastricht the Netherlands
| | - S Melman
- Department of Obstetrics and Gynaecology of Maastricht University Medical Centre+; GROW-School for Oncology and Developmental Biology; Maastricht the Netherlands
| | - SMJ van Kuijk
- Department of Epidemiology; Caphri School for Public Health and Primary Care; Maastricht University Medical Centre; Maastricht the Netherlands
| | - WA Grobman
- Feinberg School of Medicine; Northwestern University; Chicago IL USA
| | - A Kwee
- Department of Obstetrics; University Medical Centre Utrecht; Utrecht the Netherlands
| | - BWJ Mol
- Department of Obstetrics and Gynaecology; Academic Medical Centre; University of Amsterdam; Amsterdam the Netherlands
| | - JG Nijhuis
- Department of Obstetrics and Gynaecology of Maastricht University Medical Centre+; GROW-School for Oncology and Developmental Biology; Maastricht the Netherlands
| | - LJM Smits
- Department of Epidemiology; Caphri School for Public Health and Primary Care; Maastricht University Medical Centre; Maastricht the Netherlands
| | - R Aardenburg
- Department of Obstetrics and Gynaecology; Orbis Medical Centre; Sittard the Netherlands
| | - K de Boer
- Department of Obstetrics and Gynaecology; Hospital Rijnstate; Arnhem the Netherlands
| | - FMC Delemarre
- Department of Obstetrics and Gynaecology; Elkerliek Hospital; Helmond the Netherlands
| | - IM van Dooren
- Department of Obstetrics and Gynaecology; Sint Jans Gasthuis Weert; Weert the Netherlands
| | - MTM Franssen
- Department of Obstetrics and Gynaecology; Groningen University Medical Centre; Groningen the Netherlands
| | - G Kleiverda
- Department of Obstetrics and Gynaecology; Flevo Hospital; Almere the Netherlands
| | - M Kaplan
- Department of Obstetrics and Gynaecology; Röpcke-Zweers Hospital; Hardenberg the Netherlands
| | - SMI Kuppens
- Department of Obstetrics and Gynaecology; Catharina Hospital; Eindhoven the Netherlands
| | - FTH Lim
- Department of Obstetrics and Gynaecology; IJsselland Hospital; Capelle aan den IJssel the Netherlands
| | - JM Sikkema
- Department of Obstetrics and Gynaecology; ZiekenhuisGroepTwente; Almelo the Netherlands
| | - E Smid-Koopman
- Department of Obstetrics and Gynaecology; Ruwaard van Putten Ziekenhuis; Spijkenisse the Netherlands
| | - H Visser
- Department of Obstetrics and Gynaecology; Tergooi Hospital; Hilversum the Netherlands
| | - FPJM Vrouenraets
- Department of Obstetrics and Gynaecology; Atrium Medical Centre; Heerlen the Netherlands
| | - M Woiski
- Department of Obstetrics and Gynaecology; Radboud University Nijmegen Medical Centre; Nijmegen the Netherlands
| | - RPMG Hermens
- Scientific Institute for Quality of Healthcare (IQ Healthcare); Radboud University Nijmegen Medical Centre; Nijmegen the Netherlands
| | - HCJ Scheepers
- Department of Obstetrics and Gynaecology of Maastricht University Medical Centre+; GROW-School for Oncology and Developmental Biology; Maastricht the Netherlands
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15
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De Visser S, Woiski M, Hulscher M, Vandenbussche F, Scheepers L, Hermens R. P244 Development Of A Tailor-Made Implementation Strategy To Facilitate Adherence To The Dutch Postpartum Hemorrhage Guideline And Moet-Instructions. BMJ Qual Saf 2013. [DOI: 10.1136/bmjqs-2013-002293.225] [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: 11/04/2022]
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