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1. Ketonuria is not associated with hyperemesis gravidarum disease severity

Author

Koot, M.H., Grooten, I.J., Post, J.A.M. vd, Bais, J.M.J., Ris-Stalpers, C., Naaktgeboren, C.A, Niemeijer, M.N., Bremer, H.A., van der Ham, D.P., Heidema, W.M., Huisjes, A., Kleiverda, G., Kuppens, S.M., van Laar, J.O.E.H., Langenveld, J., van der Made, F., Papatsonis, D., Pelinck, M.J., Pernet, P.J., van Rheenen-Flach, L., Rijnders, R.J., Scheepers, H.C.J., Vogelvang, T.E., Mol, B.W., Roseboom, T.J., and Painter, R.C.

Published
2020
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3. External validation of prognostic models to predict stillbirth using International Prediction of Pregnancy Complications (IPPIC) Network database: individual participant data meta-analysis

Author

Allotey, J, Whittle, R, Snell, K, Smuk, M, Townsend, R, von Dadelszen, P, Heazell, A, Magee, L, Smith, G, Sandall, J, Thilaganathan, B, Zamora, J, Riley, R, Khalil, A, Thangaratinam, S, Coomarasamy, A, Kwong, A, Savitri, A, Salvesen, K, Bhattacharya, S, Uiterwaal, C, Staff, A, Andersen, L, Olive, E, Redman, C, Sletner, L, Daskalakis, G, Macleod, M, Abdollahain, M, Ramirez, J, Masse, J, Audibert, F, Magnus, P, Jenum, A, Baschat, A, Ohkuchi, A, Mcauliffe, F, West, J, Askie, L, Mone, F, Farrar, D, Zimmerman, P, Smits, L, Riddell, C, Kingdom, J, van de Post, J, Illanes, S, Holzman, C, van Kuijk, S, Carbillon, L, Villa, P, Eskild, A, Chappell, L, Prefumo, F, Velauthar, L, Seed, P, van Oostwaard, M, Verlohren, S, Poston, L, Ferrazzi, E, Vinter, C, Nagata, C, Brown, M, Vollebregt, K, Takeda, S, Langenveld, J, Widmer, M, Saito, S, Haavaldsen, C, Carroli, G, Olsen, J, Wolf, H, Zavaleta, N, Eisensee, I, Vergani, P, Lumbiganon, P, Makrides, M, Facchinetti, F, Sequeira, E, Gibson, R, Ferrazzani, S, Frusca, T, Norman, J, Figueiro, E, Lapaire, O, Laivuori, H, Lykke, J, Conde-Agudelo, A, Galindo, A, Mbah, A, Betran, A, Herraiz, I, Trogstad, L, Steegers, E, Salim, R, Huang, T, Adank, A, Zhang, J, Meschino, W, Browne, J, Allen, R, Costa, F, Klipstein-Grobusch Browne, K, Crowther, C, Jorgensen, J, Forest, J, Rumbold, A, Mol, B, Giguere, Y, Kenny, L, Ganzevoort, W, Odibo, A, Myers, J, Yeo, S, Goffinet, F, Mccowan, L, Pajkrt, E, Teede, H, Haddad, B, Dekker, G, Kleinrouweler, E, Lecarpentier, E, Roberts, C, Groen, H, Skrastad, R, Heinonen, S, Eero, K, Anggraini, D, Souka, A, Cecatti, J, Monterio, I, Pillalis, A, Souza, R, Hawkins, L, Gabbay-Benziv, R, Crovetto, F, Figuera, F, Jorgensen, L, Dodds, J, Patel, M, Aviram, A, Papageorghiou, A, Khan, K, Allotey J., Whittle R., Snell K. I. E., Smuk M., Townsend R., von Dadelszen P., Heazell A. E. P., Magee L., Smith G. C. S., Sandall J., Thilaganathan B., Zamora J., Riley R. D., Khalil A., Thangaratinam S., Coomarasamy A., Kwong A., Savitri A. I., Salvesen K. A., Bhattacharya S., Uiterwaal C. S. P. M., Staff A. C., Andersen L. B., Olive E. L., Redman C., Sletner L., Daskalakis G., Macleod M., Abdollahain M., Ramirez J. A., Masse J., Audibert F., Magnus P. M., Jenum A. K., Baschat A., Ohkuchi A., McAuliffe F. M., West J., Askie L. M., Mone F., Farrar D., Zimmerman P. A., Smits L. J. M., Riddell C., Kingdom J. C., van de Post J., Illanes S. E., Holzman C., van Kuijk S. M. J., Carbillon L., Villa P. M., Eskild A., Chappell L., Prefumo F., Velauthar L., Seed P., van Oostwaard M., Verlohren S., Poston L., Ferrazzi E., Vinter C. A., Nagata C., Brown M., Vollebregt K. C., Takeda S., Langenveld J., Widmer M., Saito S., Haavaldsen C., Carroli G., Olsen J., Wolf H., Zavaleta N., Eisensee I., Vergani P., Lumbiganon P., Makrides M., Facchinetti F., Sequeira E., Gibson R., Ferrazzani S., Frusca T., Norman J. E., Figueiro E. A., Lapaire O., Laivuori H., Lykke J. A., Conde-Agudelo A., Galindo A., Mbah A., Betran A. P., Herraiz I., Trogstad L., Smith G. G. S., Steegers E. A. P., Salim R., Huang T., Adank A., Zhang J., Meschino W. S., Browne J. L., Allen R. E., Costa F. D. S., Klipstein-Grobusch Browne K., Crowther C. A., Jorgensen J. S., Forest J. -C., Rumbold A. R., Mol B. W., Giguere Y., Kenny L. C., Ganzevoort W., Odibo A. O., Myers J., Yeo S. A., Goffinet F., McCowan L., Pajkrt E., Teede H. J., Haddad B. G., Dekker G., Kleinrouweler E. C., LeCarpentier E., Roberts C. T., Groen H., Skrastad R. B., Heinonen S., Eero K., Anggraini D., Souka A., Cecatti J. G., Monterio I., Pillalis A., Souza R., Hawkins L. A., Gabbay-Benziv R., Crovetto F., Figuera F., Jorgensen L., Dodds J., Patel M., Aviram A., Papageorghiou A., Khan K., Allotey, J, Whittle, R, Snell, K, Smuk, M, Townsend, R, von Dadelszen, P, Heazell, A, Magee, L, Smith, G, Sandall, J, Thilaganathan, B, Zamora, J, Riley, R, Khalil, A, Thangaratinam, S, Coomarasamy, A, Kwong, A, Savitri, A, Salvesen, K, Bhattacharya, S, Uiterwaal, C, Staff, A, Andersen, L, Olive, E, Redman, C, Sletner, L, Daskalakis, G, Macleod, M, Abdollahain, M, Ramirez, J, Masse, J, Audibert, F, Magnus, P, Jenum, A, Baschat, A, Ohkuchi, A, Mcauliffe, F, West, J, Askie, L, Mone, F, Farrar, D, Zimmerman, P, Smits, L, Riddell, C, Kingdom, J, van de Post, J, Illanes, S, Holzman, C, van Kuijk, S, Carbillon, L, Villa, P, Eskild, A, Chappell, L, Prefumo, F, Velauthar, L, Seed, P, van Oostwaard, M, Verlohren, S, Poston, L, Ferrazzi, E, Vinter, C, Nagata, C, Brown, M, Vollebregt, K, Takeda, S, Langenveld, J, Widmer, M, Saito, S, Haavaldsen, C, Carroli, G, Olsen, J, Wolf, H, Zavaleta, N, Eisensee, I, Vergani, P, Lumbiganon, P, Makrides, M, Facchinetti, F, Sequeira, E, Gibson, R, Ferrazzani, S, Frusca, T, Norman, J, Figueiro, E, Lapaire, O, Laivuori, H, Lykke, J, Conde-Agudelo, A, Galindo, A, Mbah, A, Betran, A, Herraiz, I, Trogstad, L, Steegers, E, Salim, R, Huang, T, Adank, A, Zhang, J, Meschino, W, Browne, J, Allen, R, Costa, F, Klipstein-Grobusch Browne, K, Crowther, C, Jorgensen, J, Forest, J, Rumbold, A, Mol, B, Giguere, Y, Kenny, L, Ganzevoort, W, Odibo, A, Myers, J, Yeo, S, Goffinet, F, Mccowan, L, Pajkrt, E, Teede, H, Haddad, B, Dekker, G, Kleinrouweler, E, Lecarpentier, E, Roberts, C, Groen, H, Skrastad, R, Heinonen, S, Eero, K, Anggraini, D, Souka, A, Cecatti, J, Monterio, I, Pillalis, A, Souza, R, Hawkins, L, Gabbay-Benziv, R, Crovetto, F, Figuera, F, Jorgensen, L, Dodds, J, Patel, M, Aviram, A, Papageorghiou, A, Khan, K, Allotey J., Whittle R., Snell K. I. E., Smuk M., Townsend R., von Dadelszen P., Heazell A. E. P., Magee L., Smith G. C. S., Sandall J., Thilaganathan B., Zamora J., Riley R. D., Khalil A., Thangaratinam S., Coomarasamy A., Kwong A., Savitri A. I., Salvesen K. A., Bhattacharya S., Uiterwaal C. S. P. M., Staff A. C., Andersen L. B., Olive E. L., Redman C., Sletner L., Daskalakis G., Macleod M., Abdollahain M., Ramirez J. A., Masse J., Audibert F., Magnus P. M., Jenum A. K., Baschat A., Ohkuchi A., McAuliffe F. M., West J., Askie L. M., Mone F., Farrar D., Zimmerman P. A., Smits L. J. M., Riddell C., Kingdom J. C., van de Post J., Illanes S. E., Holzman C., van Kuijk S. M. J., Carbillon L., Villa P. M., Eskild A., Chappell L., Prefumo F., Velauthar L., Seed P., van Oostwaard M., Verlohren S., Poston L., Ferrazzi E., Vinter C. A., Nagata C., Brown M., Vollebregt K. C., Takeda S., Langenveld J., Widmer M., Saito S., Haavaldsen C., Carroli G., Olsen J., Wolf H., Zavaleta N., Eisensee I., Vergani P., Lumbiganon P., Makrides M., Facchinetti F., Sequeira E., Gibson R., Ferrazzani S., Frusca T., Norman J. E., Figueiro E. A., Lapaire O., Laivuori H., Lykke J. A., Conde-Agudelo A., Galindo A., Mbah A., Betran A. P., Herraiz I., Trogstad L., Smith G. G. S., Steegers E. A. P., Salim R., Huang T., Adank A., Zhang J., Meschino W. S., Browne J. L., Allen R. E., Costa F. D. S., Klipstein-Grobusch Browne K., Crowther C. A., Jorgensen J. S., Forest J. -C., Rumbold A. R., Mol B. W., Giguere Y., Kenny L. C., Ganzevoort W., Odibo A. O., Myers J., Yeo S. A., Goffinet F., McCowan L., Pajkrt E., Teede H. J., Haddad B. G., Dekker G., Kleinrouweler E. C., LeCarpentier E., Roberts C. T., Groen H., Skrastad R. B., Heinonen S., Eero K., Anggraini D., Souka A., Cecatti J. G., Monterio I., Pillalis A., Souza R., Hawkins L. A., Gabbay-Benziv R., Crovetto F., Figuera F., Jorgensen L., Dodds J., Patel M., Aviram A., Papageorghiou A., and Khan K.

Abstract

Objective: Stillbirth is a potentially preventable complication of pregnancy. Identifying women at high risk of stillbirth can guide decisions on the need for closer surveillance and timing of delivery in order to prevent fetal death. Prognostic models have been developed to predict the risk of stillbirth, but none has yet been validated externally. In this study, we externally validated published prediction models for stillbirth using individual participant data (IPD) meta-analysis to assess their predictive performance. Methods: MEDLINE, EMBASE, DH-DATA and AMED databases were searched from inception to December 2020 to identify studies reporting stillbirth prediction models. Studies that developed or updated prediction models for stillbirth for use at any time during pregnancy were included. IPD from cohorts within the International Prediction of Pregnancy Complications (IPPIC) Network were used to validate externally the identified prediction models whose individual variables were available in the IPD. The risk of bias of the models and cohorts was assessed using the Prediction study Risk Of Bias ASsessment Tool (PROBAST). The discriminative performance of the models was evaluated using the C-statistic, and calibration was assessed using calibration plots, calibration slope and calibration-in-the-large. Performance measures were estimated separately in each cohort, as well as summarized across cohorts using random-effects meta-analysis. Clinical utility was assessed using net benefit. Results: Seventeen studies reporting the development of 40 prognostic models for stillbirth were identified. None of the models had been previously validated externally, and the full model equation was reported for only one-fifth (20%, 8/40) of the models. External validation was possible for three of these models, using IPD from 19 cohorts (491 201 pregnant women) within the IPPIC Network database. Based on evaluation of the model development studies, all three models had an overa

Published
2022

4. Single- versus double-layer closure of the caesarean (uterine) scar in the prevention of gynaecological symptoms in relation to niche development – the 2Close study: a multicentre randomised controlled trial

Author

Stegwee, S. I., Jordans, I. P. M., van der Voet, L. F., Bongers, M. Y., de Groot, C. J. M., Lambalk, C. B., de Leeuw, R. A., Hehenkamp, W. J. K., van de Ven, P. M., Bosmans, J. E., Pajkrt, E., Bakkum, E. A., Radder, C. M., Hemelaar, M., van Baal, W. M., Visser, H., van Laar, J. O. E. H., van Vliet, H. A. A. M., Rijnders, R. J. P., Sueters, M., Janssen, C. A. H., Hermes, W., Feitsma, A. H., Kapiteijn, K., Scheepers, H. C. J., Langenveld, J., de Boer, K., Coppus, S. F. P. J., Schippers, D. H., Oei, A. L. M., Kaplan, M., Papatsonis, D. N. M., de Vleeschouwer, L. H. M., van Beek, E., Bekker, M. N., Huisjes, A. J. M., Meijer, W. J., Deurloo, K. L., Boormans, E. M. A., van Eijndhoven, H. W. F., and Huirne, J. A. F.

Published
2019
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5. External validation of prognostic models to predict stillbirth using International Prediction of Pregnancy Complications (IPPIC) Network database: individual participant data meta-analysis

Author

Allotey, J., Whittle, R., Snell, K. I. E., Smuk, M., Townsend, R., von Dadelszen, P., Heazell, A. E. P., Magee, L., Smith, G. C. S., Sandall, J., Thilaganathan, B., Zamora, J., Riley, R. D., Khalil, A., Thangaratinam, S., Coomarasamy, A., Kwong, A., Savitri, A. I., Salvesen, K. A., Bhattacharya, S., Uiterwaal, C. S. P. M., Staff, A. C., Andersen, L. B., Olive, E. L., Redman, C., Sletner, L., Daskalakis, G., Macleod, M., Abdollahain, M., Ramirez, J. A., Masse, J., Audibert, F., Magnus, P. M., Jenum, A. K., Baschat, A., Ohkuchi, A., Mcauliffe, F. M., West, J., Askie, L. M., Mone, F., Farrar, D., Zimmerman, P. A., Smits, L. J. M., Riddell, C., Kingdom, J. C., van de Post, J., Illanes, S. E., Holzman, C., van Kuijk, S. M. J., Carbillon, L., Villa, P. M., Eskild, A., Chappell, L., Prefumo, F., Velauthar, L., Seed, P., van Oostwaard, M., Verlohren, S., Poston, L., Ferrazzi, E., Vinter, C. A., Nagata, C., Brown, M., Vollebregt, K. C., Takeda, S., Langenveld, J., Widmer, M., Saito, S., Haavaldsen, C., Carroli, G., Olsen, J., Wolf, H., Zavaleta, N., Eisensee, I., Vergani, P., Lumbiganon, P., Makrides, M., Facchinetti, F., Sequeira, E., Gibson, R., Ferrazzani, S., Frusca, T., Norman, J. E., Figueiro, E. A., Lapaire, O., Laivuori, H., Lykke, J. A., Conde-Agudelo, A., Galindo, A., Mbah, A., Betran, A. P., Herraiz, I., Trogstad, L., Smith, G. G. S., Steegers, E. A. P., Salim, R., Huang, T., Adank, A., Zhang, J., Meschino, W. S., Browne, J. L., Allen, R. E., Costa, F. D. S., Klipstein-Grobusch Browne, K., Crowther, C. A., Jorgensen, J. S., Forest, J. -C., Rumbold, A. R., Mol, B. W., Giguere, Y., Kenny, L. C., Ganzevoort, W., Odibo, A. O., Myers, J., Yeo, S. A., Goffinet, F., Mccowan, L., Pajkrt, E., Teede, H. J., Haddad, B. G., Dekker, G., Kleinrouweler, E. C., Lecarpentier, E., Roberts, C. T., Groen, H., Skrastad, R. B., Heinonen, S., Eero, K., Anggraini, D., Souka, A., Cecatti, J. G., Monterio, I., Pillalis, A., Souza, R., Hawkins, L. A., Gabbay-Benziv, R., Crovetto, F., Figuera, F., Jorgensen, L., Dodds, J., Patel, M., Aviram, A., Papageorghiou, A., Khan, K., Clinicum, HUS Gynecology and Obstetrics, Department of Obstetrics and Gynecology, HUS Children and Adolescents, Lastentautien yksikkö, Children's Hospital, Allotey, J, Whittle, R, Snell, K, Smuk, M, Townsend, R, von Dadelszen, P, Heazell, A, Magee, L, Smith, G, Sandall, J, Thilaganathan, B, Zamora, J, Riley, R, Khalil, A, Thangaratinam, S, Coomarasamy, A, Kwong, A, Savitri, A, Salvesen, K, Bhattacharya, S, Uiterwaal, C, Staff, A, Andersen, L, Olive, E, Redman, C, Sletner, L, Daskalakis, G, Macleod, M, Abdollahain, M, Ramirez, J, Masse, J, Audibert, F, Magnus, P, Jenum, A, Baschat, A, Ohkuchi, A, Mcauliffe, F, West, J, Askie, L, Mone, F, Farrar, D, Zimmerman, P, Smits, L, Riddell, C, Kingdom, J, van de Post, J, Illanes, S, Holzman, C, van Kuijk, S, Carbillon, L, Villa, P, Eskild, A, Chappell, L, Prefumo, F, Velauthar, L, Seed, P, van Oostwaard, M, Verlohren, S, Poston, L, Ferrazzi, E, Vinter, C, Nagata, C, Brown, M, Vollebregt, K, Takeda, S, Langenveld, J, Widmer, M, Saito, S, Haavaldsen, C, Carroli, G, Olsen, J, Wolf, H, Zavaleta, N, Eisensee, I, Vergani, P, Lumbiganon, P, Makrides, M, Facchinetti, F, Sequeira, E, Gibson, R, Ferrazzani, S, Frusca, T, Norman, J, Figueiro, E, Lapaire, O, Laivuori, H, Lykke, J, Conde-Agudelo, A, Galindo, A, Mbah, A, Betran, A, Herraiz, I, Trogstad, L, Steegers, E, Salim, R, Huang, T, Adank, A, Zhang, J, Meschino, W, Browne, J, Allen, R, Costa, F, Klipstein-Grobusch Browne, K, Crowther, C, Jorgensen, J, Forest, J, Rumbold, A, Mol, B, Giguere, Y, Kenny, L, Ganzevoort, W, Odibo, A, Myers, J, Yeo, S, Goffinet, F, Mccowan, L, Pajkrt, E, Teede, H, Haddad, B, Dekker, G, Kleinrouweler, E, Lecarpentier, E, Roberts, C, Groen, H, Skrastad, R, Heinonen, S, Eero, K, Anggraini, D, Souka, A, Cecatti, J, Monterio, I, Pillalis, A, Souza, R, Hawkins, L, Gabbay-Benziv, R, Crovetto, F, Figuera, F, Jorgensen, L, Dodds, J, Patel, M, Aviram, A, Papageorghiou, A, Khan, K, Tampere University, Obstetrics and Gynaecology, APH - Quality of Care, Amsterdam Reproduction & Development (AR&D), APH - Personalized Medicine, APH - Digital Health, and Obstetrics and gynaecology

Subjects
Calibration (statistics), Perinatal Death, Overfitting, Cohort Studies, Fetal Development, 0302 clinical medicine, Discriminative model, 3123 Gynaecology and paediatrics, Models, Pregnancy, GROWTH RESTRICTION, Statistics, Medicine, Prenatal, 030212 general & internal medicine, Ultrasonography, RISK, 030219 obstetrics & reproductive medicine, PRETERM, Radiological and Ultrasound Technology, LOW-DOSE ASPIRIN, DIAGNOSIS TRIPOD, Obstetrics and Gynecology, General Medicine, Statistical, Stillbirth, Prognosis, Pregnancy Complication, external validation, individual participant data, intrauterine death, prediction model, stillbirth, Female, Humans, Infant, Newborn, Models, Statistical, Pregnancy Complications, Regression Analysis, Risk Assessment, Ultrasonography, Prenatal, 3. Good health, PREECLAMPSIA, Meta-analysis, Human, Cohort study, Prognosi, MEDLINE, Regression Analysi, WEEKS GESTATION, 03 medical and health sciences, VELOCIMETRY, Radiology, Nuclear Medicine and imaging, RECURRENCE, business.industry, Infant, Newborn, R1, HYPERTENSIVE DISORDERS, Reproductive Medicine, Sample size determination, Cohort Studie, RG, business, RA, Predictive modelling
Abstract

Objective Stillbirth is a potentially preventable complication of pregnancy. Identifying women at high risk of stillbirth can guide decisions on the need for closer surveillance and timing of delivery in order to prevent fetal death. Prognostic models have been developed to predict the risk of stillbirth, but none has yet been validated externally. In this study, we externally validated published prediction models for stillbirth using individual participant data (IPD) meta-analysis to assess their predictive performance. Methods MEDLINE, EMBASE, DH-DATA and AMED databases were searched from inception to December 2020 to identify studies reporting stillbirth prediction models. Studies that developed or updated prediction models for stillbirth for use at any time during pregnancy were included. IPD from cohorts within the International Prediction of Pregnancy Complications (IPPIC) Network were used to validate externally the identified prediction models whose individual variables were available in the IPD. The risk of bias of the models and cohorts was assessed using the Prediction study Risk Of Bias ASsessment Tool (PROBAST). The discriminative performance of the models was evaluated using the C-statistic, and calibration was assessed using calibration plots, calibration slope and calibration-in-the-large. Performance measures were estimated separately in each cohort, as well as summarized across cohorts using random-effects meta-analysis. Clinical utility was assessed using net benefit. Results Seventeen studies reporting the development of 40 prognostic models for stillbirth were identified. None of the models had been previously validated externally, and the full model equation was reported for only one-fifth (20%, 8/40) of the models. External validation was possible for three of these models, using IPD from 19 cohorts (491 201 pregnant women) within the IPPIC Network database. Based on evaluation of the model development studies, all three models had an overall high risk of bias, according to PROBAST. In the IPD meta-analysis, the models had summary C-statistics ranging from 0.53 to 0.65 and summary calibration slopes ranging from 0.40 to 0.88, with risk predictions that were generally too extreme compared with the observed risks. The models had little to no clinical utility, as assessed by net benefit. However, there remained uncertainty in the performance of some models due to small available sample sizes. Conclusions The three validated stillbirth prediction models showed generally poor and uncertain predictive performance in new data, with limited evidence to support their clinical application. The findings suggest methodological shortcomings in their development, including overfitting. Further research is needed to further validate these and other models, identify stronger prognostic factors and develop more robust prediction models. (c) 2021 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Published
2022
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6. An economic analysis of immediate delivery and expectant monitoring in women with hypertensive disorders of pregnancy, between 34 and 37 weeks of gestation (HYPITAT-II)

Author

van Baaren, G-J, Broekhuijsen, K, van Pampus, MG, Ganzevoort, W, Sikkema, JM, Woiski, MD, Oudijk, MA, Bloemenkamp, KWM, Scheepers, HCJ, Bremer, HA, Rijnders, RJP, van Loon, AJ, Perquin, DAM, Sporken, JMJ, Papatsonis, DNM, van Huizen, ME, Vredevoogd, CB, Brons, JTJ, Kaplan, M, van Kaam, AH, Groen, H, Porath, M, van den Berg, PP, Mol, BWJ, Franssen, MTM, and Langenveld, J

Published
2016
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7. An Economic Analysis of Immediate Delivery and Expectant Monitoring in Women With Hypertensive Disorders of Pregnancy, Between 34 and 37 Weeks of Gestation (HYPITAT-II)

Author

van Baaren, G-J, Broekhuijsen, K., van Pampus, M.G., Ganzevoort, W., Sikkema, J.M., Woiski, M.D., Oudijk, M.A., Bloemenkamp, K.W.M., Scheepers, H.C.J., Bremer, H.A., Rijnders, R.J.P., van Loon, A.J., Perquin, D.A.M., Sporken, J.M.J., Papatsonis, D.N.M., van Huizen, M.E., Vredevoogd, C.B., Brons, J.T.J., Kaplan, M., van Kaam, A.H., Groen, H., Porath, M., van den Berg, P.P., Mol, B.W.J., Franssen, M.T.M., and Langenveld, J.

Published
2017
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9. Depression, anxiety, and post-traumatic stress disorder symptoms after hyperemesis gravidarum: a prospective cohort study

Author

Nijsten, K., Minnen, L.M. van der, Dean, C., Bais, J.M., Ris-Stalpers, C., Eekelen, R. van, Bremer, H.A., Ham, D.P. van der, Heidema, W.M., Huisjes, A., Kleiverda, G., Kuppens, S.M., Laar, J. van, Langenveld, J., Made, F. van der, Papatsonis, D., Pelinck, M.J., Pernet, P.J., Rheenen-Flach, L. van, Rijnders, R.J., Scheepers, H.C., Vogelvang, T., Mol, B.W.J., Olff, M., Roseboom, T.J., Koot, M.H., Grooten, I.J., Painter, R.C., Nijsten, K., Minnen, L.M. van der, Dean, C., Bais, J.M., Ris-Stalpers, C., Eekelen, R. van, Bremer, H.A., Ham, D.P. van der, Heidema, W.M., Huisjes, A., Kleiverda, G., Kuppens, S.M., Laar, J. van, Langenveld, J., Made, F. van der, Papatsonis, D., Pelinck, M.J., Pernet, P.J., Rheenen-Flach, L. van, Rijnders, R.J., Scheepers, H.C., Vogelvang, T., Mol, B.W.J., Olff, M., Roseboom, T.J., Koot, M.H., Grooten, I.J., and Painter, R.C.

Abstract

Item does not contain fulltext, OBJECTIVE: To determine the prevalence of depression, anxiety, and posttraumatic stress disorder (PTSD) years after hyperemesis gravidarum (HG) and its association with HG severity. MATERIAL AND METHODS: This prospective cohort study consisted of a follow-up of 215 women admitted for HG, who were eligible to participate in a randomized controlled trial and either declined or agreed to be randomized between 2013 and 2016 in 19 hospitals in the Netherlands. Participants completed the Hospital Anxiety and Depression Scale (HADS) six weeks postpartum and during follow-up and the PTSD checklist for DSM-5 (PCL-5) during follow-up. An anxiety or depression score ≥8 is indicative of an anxiety or depression disorder and a PCL-5 ≥ 31 indicative of PTSD. Measures of HG severity were symptom severity (PUQE-24: Pregnancy Unique Quantification of Emesis), weight change, duration of admissions, readmissions, and admissions after the first trimester. RESULTS: About 54/215 participants completed the HADS six weeks postpartum and 73/215 participants completed the follow-up questionnaire, on average 4.5 years later. Six weeks postpartum, 13 participants (24.1%) had an anxiety score ≥8 and 11 participants (20.4%) a depression score ≥8. During follow-up, 29 participants (39.7%) had an anxiety score ≥8, 20 participants (27.4%) a depression score ≥8, and 16 participants (21.9%) a PCL-5 ≥ 31.Multivariable logistic regression analysis showed that for every additional point of the mean PUQE-24 three weeks after inclusion, the likelihood of having an anxiety score ≥8 and PCL-5 ≥ 31 at follow-up increased with OR 1.41 (95% CI: 1.10;1.79) and OR 1.49 (95% CI: 1.06;2.10) respectively. CONCLUSION: Depression, anxiety, and PTSD symptoms are common years after HG occurred.

Published
2022

10. An economic analysis of immediate delivery and expectant monitoring in women with hypertensive disorders of pregnancy, between 34 and 37 weeks of gestation (HYPITAT‐II)

Author

van Baaren, G‐J, Broekhuijsen, K, van Pampus, MG, Ganzevoort, W, Sikkema, JM, Woiski, MD, Oudijk, MA, Bloemenkamp, KWM, Scheepers, HCJ, Bremer, HA, Rijnders, RJP, van Loon, AJ, Perquin, DAM, Sporken, JMJ, Papatsonis, DNM, van Huizen, ME, Vredevoogd, CB, Brons, JTJ, Kaplan, M, van Kaam, AH, Groen, H, Porath, M, van den Berg, PP, Mol, BWJ, Franssen, MTM, and Langenveld, J

Published
2017
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11. External validation of prognostic models to predict stillbirth using International Prediction of Pregnancy Complications ( <scp>IPPIC</scp> ) Network database: individual participant data meta‐analysis

Author

Allotey, J, Whittle, R, Snell, KIE, Smuk, M, Townsend, R, Dadelszen, P, Heazell, AEP, Magee, L, Smith, GCS, Sandall, J, Thilaganathan, B, Zamora, J, Riley, RD, Khalil, A, Thangaratinam, S, Coomarasamy, A, Kwong, A, Savitri, AI, Salvesen, KÅ, Bhattacharya, S, Uiterwaal, CSPM, Staff, AC, Andersen, LB, Olive, EL, Redman, C, Sletner, L, Daskalakis, G, Macleod, M, Abdollahain, M, Ramírez, JA, Massé, J, Audibert, F, Magnus, PM, Jenum, AK, Baschat, A, Ohkuchi, A, McAuliffe, FM, West, J, Askie, LM, Mone, F, Farrar, D, Zimmerman, PA, Smits, LJM, Riddell, C, Kingdom, JC, Post, J, Illanes, SE, Holzman, C, Kuijk, SMJ, Carbillon, L, Villa, PM, Eskild, A, Chappell, L, Prefumo, F, Velauthar, L, Seed, P, Oostwaard, M, Verlohren, S, Poston, L, Ferrazzi, E, Vinter, CA, Nagata, C, Brown, M, Vollebregt, KC, Takeda, S, Langenveld, J, Widmer, M, Saito, S, Haavaldsen, C, Carroli, G, Olsen, J, Wolf, H, Zavaleta, N, Eisensee, I, Vergani, P, Lumbiganon, P, Makrides, M, Facchinetti, F, Sequeira, E, Gibson, R, Ferrazzani, S, Frusca, T, Norman, JE, Figueiró‐Filho, EA, Lapaire, O, Laivuori, H, Lykke, JA, Conde‐Agudelo, A, Galindo, A, Mbah, A, Betran, AP, Herraiz, I, Trogstad, L, Smith, GGS, Steegers, EAP, Salim, R, Huang, T, Adank, A, Zhang, J, Meschino, WS, Browne, JL, Allen, RE, Costa, F Da Silva, Klipstein‐Grobusch, K, Crowther, CA, Jørgensen, JS, Forest, J‐C, Rumbold, AR, Mol, BW, Giguère, Y, Kenny, LC, Ganzevoort, W, Odibo, AO, Myers, J, Yeo, SA, Goffinet, F, McCowan, L, Pajkrt, E, Teede, HJ, Haddad, BG, Dekker, G, Kleinrouweler, EC, LeCarpentier, É, Roberts, CT, Groen, H, Skråstad, RB, Heinonen, S, Eero, K, Anggraini, D, Souka, A, Cecatti, JG, Monterio, I, Pillalis, A, Souza, R, Hawkins, LA, Gabbay‐Benziv, R, Crovetto, F, Figuera, F, Jorgensen, L, Dodds, J, Patel, M, Aviram, A, Papageorghiou, A, and Khan, K

Abstract

Objective: Stillbirth is a potentially preventable complication of pregnancy. Identifying women at risk can guide decisions on closer surveillance or timing of birth to prevent fetal death.Prognostic models have been developed to predict the risk of stillbirth, but none have yet been externally validated. We externally validated published prediction models for stillbirth using individual participant data (IPD) meta-analysis to assess their predictive performance. Methods: We searched Medline, EMBASE, DH-DATA and AMED databases from inception to December 2020 to identify stillbirth prediction models. We included studies that developed or updated prediction models for stillbirth for use at any time during pregnancy. IPD from cohorts within the International Prediction of Pregnancy Complication (IPPIC) Network were used to externally validate the identified prediction models whose individual variables were available in the IPD. We assessed the risk of bias of the models and IPD using PROBAST, and reported discriminative performance using the C-statistic, and calibration performance using calibration plots, calibration slopeand calibration-in-the-large. We estimated performance measures separately in each study, and then summarised across studies using random-effects meta-analysis. Clinical utility was assessed using net benefit. Results: We identified 17 studies reporting the development of 40 prognostic models for stillbirth. None of the models were previously externally validated, and only a fifth (20%, 8/40) reported the full model equation. We were able to validate three of these models using the IPD from 19 cohort studies (491,201 pregnant women) within the IPPIC Network database. Based on evaluating their development studies, all three models had an overall high risk of bias according to PROBAST. In our IPD meta-analysis, the models had summary C-statistics ranging from 0.53 to 0.65; summary calibration slopes of 0.40to 0.88, and generally with observed risks predictions that were too extreme compared to observed risks; and little to no clinical utility as assessed by net benefit. However, there remained uncertainty in performance for some models due to small available sample sizes. Conclusion: The three validated models generally showed poor and uncertain predictive performancein new data, with limited evidence to support their clinical application. Findings suggest methodological shortcomings in their development including overfitting of models. Further research is needed to further validate these and other models, identify stronger prognostic factors, and to develop more robust prediction models

Published
2021

13. Thyroid-stimulating hormone and free thyroxine fail to predict the severity and clinical course of hyperemesis gravidarum: A prospective cohort study

Author

Nijsten, K., Koot, M.H., Post, J.A.M. van der, Bais, J.M., Ris-Stalpers, C., Naaktgeboren, C., Bremer, H.A., Ham, D.P. van der, Heidema, W.M., Huisjes, A., Kleiverda, G., Kuppens, S.M., Laar, J. van, Langenveld, J., Made, F. van der, Papatsonis, D., Pelinck, M.J., Pernet, P.J., Rheenen-Flach, L. van, Rijnders, R.J., Scheepers, H.C., Siegelaar, S.E., Vogelvang, T., Mol, B.W.J., Roseboom, T.J., Grooten, I.J., Painter, R.C., Nijsten, K., Koot, M.H., Post, J.A.M. van der, Bais, J.M., Ris-Stalpers, C., Naaktgeboren, C., Bremer, H.A., Ham, D.P. van der, Heidema, W.M., Huisjes, A., Kleiverda, G., Kuppens, S.M., Laar, J. van, Langenveld, J., Made, F. van der, Papatsonis, D., Pelinck, M.J., Pernet, P.J., Rheenen-Flach, L. van, Rijnders, R.J., Scheepers, H.C., Siegelaar, S.E., Vogelvang, T., Mol, B.W.J., Roseboom, T.J., Grooten, I.J., and Painter, R.C.

Abstract

Item does not contain fulltext, INTRODUCTION: Little is known about the pathophysiology of hyperemesis gravidarum (HG). Proposed underlying causes are multifactorial and thyroid function is hypothesized to be causally involved. In this study, we aimed to assess the utility of thyroid-stimulating hormone (TSH) and free thyroxine (FT4) as a marker and predictor for the severity and clinical course of HG. MATERIAL AND METHODS: We conducted a prospective cohort study including women admitted for HG between 5 and 20 weeks of gestation in 19 hospitals in the Netherlands. Women with a medical history of thyroid disease were excluded. TSH and FT4 were measured at study entry. To adjust for gestational age, we calculated TSH multiples of the median (MoM). We assessed HG severity at study entry as severity of nausea and vomiting (by the Pregnancy Unique Quantification of Emesis and nausea score), weight change compared with prepregnancy weight, and quality of life. We assessed the clinical course of HG as severity of nausea and vomiting and quality of life 1 week after inclusion, duration of hospital admissions, and readmissions. We performed multivariable regression analysis with absolute TSH, TSH MoMs, and FT4. RESULTS: Between 2013 and 2016, 215 women participated in the cohort. TSH, TSH MoM, and FT4 were available for, respectively, 150, 126, and 106 of these women. Multivariable linear regression analysis showed that lower TSH MoM was significantly associated with increased weight loss or lower weight gain at study entry (ΔKg; β = 2.00, 95% CI 0.47-3.53), whereas absolute TSH and FT4 were not. Lower TSH, not lower TSH MoM or FT4, was significantly associated with lower nausea and vomiting scores 1 week after inclusion (β = 1.74, 95% CI 0.36-3.11). TSH and FT4 showed no association with any of the other markers of the severity or clinical course of HG. Twenty-one out of 215 (9.8%) women had gestational transient thyrotoxicosis. Women with gestational transient thyrotoxicosis had a lower quality of life

Published
2021

14. Restrictive versus liberal fluid resuscitation strategy, influence on blood loss and hemostatic parameters in mild obstetric hemorrhage: An open-label randomized controlled trial. (REFILL study)

Author

Schol, P.B.B., Lange, N.M. de, Woiski, M.D., Langenveld, J., Smits, L.J.M, Wassen, M.M., Henskens, Y.M., Scheepers, H.C., Schol, P.B.B., Lange, N.M. de, Woiski, M.D., Langenveld, J., Smits, L.J.M, Wassen, M.M., Henskens, Y.M., and Scheepers, H.C.

Abstract

Contains fulltext : 235799.pdf (Publisher’s version ) (Open Access), BACKGROUND: Evidence for optimal hemostatic resuscitation in postpartum hemorrhage (PPH) is lacking. Liberal fluid administration may result in acidosis, hypothermia and coagulopathy. OBJECTIVE: We hypothesize that in early PPH a restrictive fluid administration results in less progression to moderate PPH. STUDY DESIGN: In four Dutch hospitals we recruited women of 18 years and over, and more than 24 weeks pregnant. Exclusion criteria were: anticoagulant therapy, known coagulation disorders, pre-eclampsia, antenatal diagnosis of abnormally adhesive placenta, and a contraindication for liberal fluid therapy. We blindly randomized participants at 500 mL and ongoing blood loss in the third stage of labor between restrictive fluid administration (clear fluids 0.75-1.0 times the volume of blood lost) and liberal fluid administration (clear fluids 1.5-2.0 times the volume of blood lost). The primary outcome was progression to more than 1000 mL blood loss. Analyses were according to the intention-to-treat principle. RESULTS: From August 2014 till September 2019, 5190 women were informed of whom 1622 agreed to participate. A total of 252 women were randomized of which 130 were assigned to the restrictive group and 122 to the liberal group. In the restrictive management group 51 of the 130 patients (39.2%) progressed to more than 1000 mL blood loss versus 61 of the 119 patients (51.3%) in the liberal management group (difference, -12.0% [95%-CI -24.3% to 0.3%], p = 0.057). There was no difference in the need for blood transfusion, coagulation parameters, or in adverse events between the groups. CONCLUSIONS: Although a restrictive fluid resuscitation in women with mild PPH could not been proven to be superior, it does not increase the need for blood transfusion, alter coagulation parameters, or cause a rise in adverse events. It can be considered as an alternative treatment option to liberal fluid resuscitation. TRIAL REGISTRATION: NTR3789.

Published
2021

15. Recurrence, postponing pregnancy, and termination rates after hyperemesis gravidarum: Follow up of the MOTHER study

Author

Nijsten, K., Dean, C., Minnen, L.M. van der, Bais, J.M., Ris-Stalpers, C., Eekelen, R. van, Bremer, H.A., Ham, D.P. van der, Heidema, W.M., Huisjes, A., Kleiverda, G., Kuppens, S.M., Laar, J. van, Langenveld, J., Made, F. van der, Papatsonis, D., Pelinck, M.J., Pernet, P.J., Rheenen-Flach, L. van, Rijnders, R.J., Scheepers, H.C., Vogelvang, T., Mol, B.W.J., Roseboom, T.J., Koot, M.H., Grooten, I.J., Painter, R.C., Nijsten, K., Dean, C., Minnen, L.M. van der, Bais, J.M., Ris-Stalpers, C., Eekelen, R. van, Bremer, H.A., Ham, D.P. van der, Heidema, W.M., Huisjes, A., Kleiverda, G., Kuppens, S.M., Laar, J. van, Langenveld, J., Made, F. van der, Papatsonis, D., Pelinck, M.J., Pernet, P.J., Rheenen-Flach, L. van, Rijnders, R.J., Scheepers, H.C., Vogelvang, T., Mol, B.W.J., Roseboom, T.J., Koot, M.H., Grooten, I.J., and Painter, R.C.

Abstract

Contains fulltext : 238920.pdf (Publisher’s version ) (Open Access), INTRODUCTION: Hyperemesis gravidarum (HG) complicates 1% of pregnancies and has a major impact on maternal quality of life and well-being. We know very little about HG's long-term impact after an affected pregnancy, including recurrence rates in future pregnancies, which is essential information for women considering subsequent pregnancies. In this study, we aimed to prospectively measure the recurrence rate of HG and the number of postponed and terminated subsequent pregnancies due to HG. We also aimed to evaluate if there were predictive factors that could identify women at increased risk for HG recurrence, and postponing and terminating subsequent pregnancies. MATERIAL AND METHODS: We conducted a prospective cohort study. A total of 215 women admitted for HG to public hospitals in the Netherlands were enrolled in the original MOTHER randomized controlled trial and associated observational cohort. Seventy-three women were included in this follow-up study. Data were collected through an online questionnaire. Recurrent HG was defined as vomiting symptoms accompanied by any of the following: multiple medication use, weight loss, admission, tube feeding or if nausea and vomiting symptoms were severe enough to affect life and/or work. Outcome measures were recurrence, postponing, and termination rates due to HG. Univariable logistic regression analysis was used to identify predictive factors associated with HG recurrence, and postponing and terminating subsequent pregnancies. RESULTS: Thirty-five women (48%) became pregnant again of whom 40% had postponed their pregnancy due to HG. HG recurred in 89% of pregnancies. One woman terminated and eight women (23%) considered terminating their pregnancy because of recurrent HG. Twenty-four out of 38 women did not get pregnant again because of HG in the past. Univariable logistic regression analysis identifying possible predictive factors found that having a western background was associated with having weight loss due to recu

Published
2021

16. External validation of a prediction model on vaginal birth after caesarean in a The Netherlands: a prospective cohort study

Author

Vankan, E., Kuijk, S.M.J. Van, Nijhuis, J.G., Aardenburg, R., Delemarre, F.M., Dirksen, C.D., Dooren, I.M. van, Kuppens, S.M., Kwee, A., Langenveld, J., Schoorel, E.N., Smits, L.J.M, Hermens, R.P.M.G., Scheepers, H.C., Vankan, E., Kuijk, S.M.J. Van, Nijhuis, J.G., Aardenburg, R., Delemarre, F.M., Dirksen, C.D., Dooren, I.M. van, Kuppens, S.M., Kwee, A., Langenveld, J., Schoorel, E.N., Smits, L.J.M, Hermens, R.P.M.G., and Scheepers, H.C.

Abstract

Item does not contain fulltext, OBJECTIVES: Discussing the individual probability of a successful vaginal birth after caesarean (VBAC) can support decision making. The aim of this study is to externally validate a prediction model for the probability of a VBAC in a Dutch population. METHODS: In this prospective cohort study in 12 Dutch hospitals, 586 women intending VBAC were included. Inclusion criteria were singleton pregnancies with a cephalic foetal presentation, delivery after 37 weeks and one previous caesarean section (CS) and preference for intending VBAC. The studied prediction model included six predictors: pre-pregnancy body mass index, previous vaginal delivery, previous CS because of non-progressive labour, Caucasian ethnicity, induction of current labour, and estimated foetal weight ≥90th percentile. The discriminative and predictive performance of the model was assessed using receiver operating characteristic curve analysis and calibration plots. RESULTS: The area under the curve was 0.73 (CI 0.69-0.78). The average predicted probability of a VBAC according to the prediction model was 70.3% (range 33-92%). The actual VBAC rate was 71.7%. The calibration plot shows some overestimation for low probabilities of VBAC and an underestimation of high probabilities. CONCLUSIONS: The prediction model showed good performance and was externally validated in a Dutch population. Hence it can be implemented as part of counselling for mode of delivery in women choosing between intended VBAC or planned CS after previous CS.

Published
2021

20. Association of Timing of Plasma Transfusion With Adverse Maternal Outcomes in Women With Persistent Postpartum Hemorrhage

Author

Henriquez, D.D.C.A., Caram-Deelder, C., Cessie, S. le, Zwart, J.J., Roosmalen, J.J.M. van, Eikenboom, J.C.J., So-Osman, C., Watering, L.G. van de, Zwaginga, J.J., Koopman-van Gemert, A.W.M.M., Bloemenkamp, K.W.M., Bom, J.G. van der, Bank, C.M.C., Snuif-de Lange, Y.S., Gammeren, A.J. van, Papatsonis, D.N.M., Klinkspoor, H., Kok, M., Boer, B.A. de, Langenveld, J., Leers, M.P.G., Diris, J.H.C., Kok, R.D., Engbers, P., Hanssen, M.J.C.P., Wijngaarden, W.J. van, Schippers, D.H., Stappen, J.J. van der, Hasaart, T.H.M., Kerkhof, D.H. van de, Kok, J.B. de, Unnik, G.A. van, Kortlandt, W., Schuitemaker, N.E., Delemarre, F.M.C., Duijnhoven, H.L.P. van, Duvekot, H.J., Hogenboom, S., Kleiverda, G., Etten-van Hulst, M.J.W. van, Mirani-Oostdijk, K.P., Kampen, C. van, Weinans, M.J.N., Adriaanse, H.J., Huisjes, A.J.M., Frasa, M.A.M., Keuren, J.F.W., Meir, C.A. van, Feitsma, H., Hudig, F., Sikkema, J.M., Baas, M.I., Fouraux, M.A., Hmetz, G.C., Bijvank, B.H.N., Rondeel, H.J.M., Roelofsen, J.M.T., Doesburg-van Kleffens, M., Wit, S.C. de, Versendaal, H., Weerkamp, F., Henskens, Y.M.C., Scheepers, L.H.C.J., Ham, D.P. van der, Smit, J.W., Graaf, F. van der, Porath, M.M., Salm, P.C.M. van der, Wijnen, M. van, Pontesilli, M., Dunne, F.M. van, Ponjee, G.A.E., Post, M.S., Veen, B.S. van der, Brons, J.T.J., Slomp, J., Mare, A. de, Leyte, A., Akker, E.S.A. van den, Wet, H. de, Borden, D.M.R. van der, Bremer, H.A., Tax, G.H.M., Vries, M.J. de, Boer, K. de, Waard, H. de, Keijzer, R.H. de, Burggraaff, J.M., Pouwels, J.G.J., Gemund, N. van, Prinzen, L., Hendriks, H.A., Hermsen, B.B.J., Koehorst, S.G.A., Verhagen, T.E.M., Beek, E. van, Hackeng, C.M., Kabel, P.J., Steures, P., Dooren, I.A. van, Michielse, E.C.H.J., Chon, H., Treskes, M., Visser, H., Oostenveld, E., Peters, D.H.M., Franssen, M.T.M., Meekers, J.H., Woiski, M.D., Pampus, L.C.M. van, Oudijk, M.A., Vooght, K.M.K. de, Cikot, R.L.M., Mostert, L.J., Ceelie, H., Huijssoon, A.M.G., Groot, C.J.M. de, Visser, O., Jonker, N., Koops, A., Hooker, A., Osmanovic, N., Ulenkate, H.J.L.M., Visschers, B., Martens, G.D.M., TeMpOH-Res Grp, Athena Institute, APH - Global Health, APH - Quality of Care, Reproductive Origins of Adult Health and Disease (ROAHD), Faculteit FHML Centraal, RS: CARIM - R1.04 - Clinical thrombosis and haemostasis, MUMC+: DA CDL Algemeen (9), Med Microbiol, Infect Dis & Infect Prev, Obstetrie & Gynaecologie, MUMC+: MA Medische Staf Obstetrie Gynaecologie (9), RS: GROW - R4 - Reproductive and Perinatal Medicine, RS: Carim - B04 Clinical thrombosis and Haemostasis, and Obstetrics & Gynecology

Subjects
Adult, medicine.medical_specialty, medicine.medical_treatment, TRACHEAL INTUBATION, Blood Component Transfusion, Time-to-Treatment, Cohort Studies, MULTIPLE IMPUTATION, DOUBLE-BLIND, Plasma, PROPENSITY SCORE ANALYSIS, SDG 3 - Good Health and Well-being, medicine, Coagulopathy, MANAGEMENT, Humans, Original Investigation, FIBRINOGEN CONCENTRATE, COAGULOPATHY, Hysterectomy, business.industry, Obstetrics, Incidence (epidemiology), Research, Incidence, Postpartum Hemorrhage, HOSPITAL CARDIAC-ARREST, Obstetrics and Gynecology, TRANEXAMIC ACID, General Medicine, Odds ratio, Puerperal Disorders, medicine.disease, Uterine atony, Online Only, BALANCE, Propensity score matching, Female, business, Cohort study
Abstract

This cohort study examines the association of timing of receipt of plasma transfusions among women experiencing persistent postpartum hemorrhage with adverse maternal outcomes., Key Points Question Is plasma transfusion within the first 60 minutes of persistent postpartum hemorrhage (PPH) associated with incidence of maternal adverse outcomes? Findings In this cohort study of 114 propensity score–matched women with persistent PPH, plasma transfusion within the first 60 minutes of persistent PPH was not associated with incidence of maternal adverse outcomes compared with no or later plasma transfusion, independent of severity of PPH at the time of plasma transfusion. Meaning These findings do not support the theory that early plasma transfusion in women with persistent PPH is better than no or later plasma transfusion., Importance Early plasma transfusion for women with severe postpartum hemorrhage (PPH) is recommended to prevent coagulopathy. However, there is no comparative, quantitative evidence on the association of early plasma transfusion with maternal outcomes. Objective To compare the incidence of adverse maternal outcomes among women who received plasma during the first 60 minutes of persistent PPH vs women who did not receive plasma for similarly severe persistent PPH. Design, Setting, and Participants This multicenter cohort study used a consecutive sample of women with persistent PPH, defined as PPH refractory to first-line measures to control bleeding, between January 1, 2011, and January 1, 2013. Time-dependent propensity score matching was used to select women who received plasma during the first 60 minutes of persistent PPH and match each of them with a woman who had shown the same severity and received the same treatment of PPH but who had not received plasma at the moment of matching. Transfusions were not guided by coagulation tests. Statistical analysis was performed from June 2018 to June 2019. Exposures Transfusion of plasma during the first 60 minutes of persistent PPH vs no or later plasma transfusion. Main Outcomes and Measures Incidence of adverse maternal outcomes, defined as a composite of death, hysterectomy, or arterial embolization. Results This study included 1216 women (mean [SD] age, 31.6 [5.0] years) with persistent PPH, of whom 932 (76.6%) delivered vaginally and 780 (64.1%) had PPH caused by uterine atony. Seven women (0.6%) died because of PPH, 62 women (5.1%) had a hysterectomy, and 159 women (13.1%) had arterial embolizations. Among women who received plasma during the first 60 minutes of persistent PPH, 114 women could be matched with a comparable woman who had not received plasma at the moment of matching. The incidence of adverse maternal outcomes was similar between the women, with adverse outcomes recorded in 24 women (21.2%) who received early plasma transfusion and 23 women (19.9%) who did not receive early plasma transfusion (odds ratio, 1.09; 95% CI, 0.57-2.09). Results of sensitivity analyses were comparable to the primary results. Conclusions and Relevance In this cohort study, initiation of plasma transfusion during the first 60 minutes of persistent PPH was not associated with adverse maternal outcomes compared with no or later plasma transfusion, independent of severity of PPH.

Published
2019
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21. Clinical characteristics of women captured by extending the definition of severe postpartum haemorrhage with ‘refractoriness to treatment’: a cohort study

Author

Henriquez, D.D.C.A., Gillissen, A., Smith, S.M., Cramer, R.A., Akker, T. van den, Zwart, J.J., Roosmalen, J.J.M. van, Bloemenkamp, K.W.M., Bom, J.G. van der, Adriaanse, H.J., Akker, E.S.A. van den, Baas, M.I., Bank, C.M.C., Beek, E. van, Boer, B.A. de, Boer, K. de, Borden, D.M.R. van der, Bremer, H.A., Brons, J.T.J., Burggraaff, J.M., Ceelie, H., Chon, H., Cikot, J.L.M., Delemarre, F.M.C., Diris, J.H.C., Doesburg-van Kleffens, M., Dooren, I.M.A. van, Duijnhoven, J.L.P. van, Dunn, F.M. van, Duvekot, J.J., Engbers, P., Etten-van Hulst, M.J.W. van, Feitsma, H., Fouraux, M.A., Franssen, M.T.M., Frasa, M.A.M., Gammeren, A.J. van, Gemund, N. van, Graaf, F. van der, Groot, C.J.M. de, Hackeng, C.M., Ham, D.P. van der, Hanssen, M.J.C.P., Hasaart, T.H.M., Hendriks, H.A., Henskens, Y.M.C., Hermsen, B.B.J., Hogenboom, S., Hooker, A., Hudig, F., Huijssoon, A.M.G., Huisjes, A.J.M., Jonker, N., Kabel, P.J., Kampen, C. van, Keijzer, M.H. de, Kerkhof, D.H. van de, Keuren, J.F.W., Kleiverda, G., Klinkspoor, J.H., Koehorst, S.G.A., Kok, M., Kok, R.D., Kok, J.B. de, Koops, A., Kortlandt, W., Langenveld, J., Leers, M.P.G., Leyte, A., Mare, A. de, Martens, G.D.M., Meekers, J.H., Meir, C.A. van, Metz, G.C.H., Michielse, E.C.H.J., Mostert, L.J., Bijvank, S.W.H.N., Oostenveld, E., Osmanovic, N., Oudijk, M.A., Mirani-Oostdijk, C.P., Pampus, E.C.M. van, Papatsonis, D.N.M., Peters, R.H.M., Ponjee, G.A.E., Pontesilli, M., Porath, M.M., Post, M.S., Pouwels, J.G.J., Prinzen, L., Roelofsen, J.M.T., Rondeel, J.J.M., Salm, P.C.M. van der, Scheepers, H.C.J., Schippers, D.H., Schuitemaker, N.W.E., Sikkema, J.M., Slomp, J., Smit, J.W., Snuif-de Lange, Y.S., Stappen, J.W.J. van der, Steures, P., Tax, G.H.M., Treskes, M., Ulenkate, H.J.L.M., Unnik, G.A. van, Veen, B.S. van der, Verhagen, T.E.M., Versendaal, J., Visschers, B., Visser, O., Visser, H., Vooght, K.M.K. de, Vries, M.J. de, Waard, H. de, Weerkamp, F., Weinans, M.J.N., Wet, H. de, Wijnen, M. van, Wijngaarden, W.J. van, Wit, A.C. de, Woiski, M.D., TeMpOH-1 Study Grp, Obstetrics & Gynecology, Science Communication, APH - Global Health, Athena Institute, APH - Quality of Care, Reproductive Origins of Adult Health and Disease (ROAHD), Ethics, Law & Medical humanities, Cardiology, ACS - Heart failure & arrhythmias, Obstetrics and gynaecology, Amsterdam Reproduction & Development (AR&D), Pediatric surgery, Hematology, Faculteit FHML Centraal, RS: CARIM - R1.04 - Clinical thrombosis and haemostasis, MUMC+: DA CDL Algemeen (9), RS: GROW - R4 - Reproductive and Perinatal Medicine, MUMC+: MA Medische Staf Obstetrie Gynaecologie (9), Obstetrie & Gynaecologie, and RS: Carim - B04 Clinical thrombosis and Haemostasis

Subjects
Male, Blood transfusion, Refractory period, medicine.medical_treatment, 030204 cardiovascular system & hematology, Severity of Illness Index, law.invention, Postpartum haemorrhage, 0302 clinical medicine, law, Pregnancy, Risk Factors, Netherlands, 030219 obstetrics & reproductive medicine, Obstetrics, Incidence, Obstetrics and Gynecology, Prognosis, Intensive care unit, Embolization, Therapeutic, PREVALENCE, Survival Rate, Female, Cohort study, Research Article, Maternal mortality, Adult, medicine.medical_specialty, Reproductive medicine, Other Research Radboud Institute for Molecular Life Sciences [Radboudumc 0], Hysterectomy, lcsh:Gynecology and obstetrics, 03 medical and health sciences, All institutes and research themes of the Radboud University Medical Center, SDG 3 - Good Health and Well-being, medicine, Humans, Blood Transfusion, lcsh:RG1-991, Retrospective Studies, SEVERE MATERNAL MORBIDITY, business.industry, Other Research Radboud Institute for Health Sciences [Radboudumc 0], Postpartum Hemorrhage, Infant, Newborn, Retrospective cohort study, Definition, Packed red blood cells, business, Maternal morbidity, Follow-Up Studies
Abstract

Background The absence of a uniform and clinically relevant definition of severe postpartum haemorrhage hampers comparative studies and optimization of clinical management. The concept of persistent postpartum haemorrhage, based on refractoriness to initial first-line treatment, was proposed as an alternative to common definitions that are either based on estimations of blood loss or transfused units of packed red blood cells (RBC). We compared characteristics and outcomes of women with severe postpartum haemorrhage captured by these three types of definitions. Methods In this large retrospective cohort study in 61 hospitals in the Netherlands we included 1391 consecutive women with postpartum haemorrhage who received either ≥4 units of RBC or a multicomponent transfusion. Clinical characteristics and outcomes of women with severe postpartum haemorrhage defined as persistent postpartum haemorrhage were compared to definitions based on estimated blood loss or transfused units of RBC within 24 h following birth. Adverse maternal outcome was a composite of maternal mortality, hysterectomy, arterial embolisation and intensive care unit admission. Results One thousand two hundred sixty out of 1391 women (90.6%) with postpartum haemorrhage fulfilled the definition of persistent postpartum haemorrhage. The majority, 820/1260 (65.1%), fulfilled this definition within 1 h following birth, compared to 819/1391 (58.7%) applying the definition of ≥1 L blood loss and 37/845 (4.4%) applying the definition of ≥4 units of RBC. The definition persistent postpartum haemorrhage captured 430/471 adverse maternal outcomes (91.3%), compared to 471/471 (100%) for ≥1 L blood loss and 383/471 (81.3%) for ≥4 units of RBC. Persistent postpartum haemorrhage did not capture all adverse outcomes because of missing data on timing of initial, first-line treatment. Conclusion The definition persistent postpartum haemorrhage identified women with severe postpartum haemorrhage at an early stage of haemorrhage, unlike definitions based on blood transfusion. It also captured a large majority of adverse maternal outcomes, almost as large as the definition of ≥1 L blood loss, which is commonly applied as a definition of postpartum haemorrhage rather than severe haemorrhage.

Published
2019
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22. Fluid resuscitation during persistent postpartum haemorrhage and maternal outcome: A nationwide cohort study

Author

Henriquez, D.D.C.A., Bloemenkamp, K.W.M., Loeff, R.M., Zwart, J.J., Roosmalen, J.J.M. van, Zwaginga, J.J., Bom, J.G. van der, Adriaanse, H.J., Akker, E.S.A. van den, Baas, M.I., Bank, C.M.C., Beek, E. van, Boer, B.A. de, Boer, K. de, Borden, D.M.R. van der, Bremer, H.A., Brons, J.T.J., Burggraaff, J.M., Ceelie, H., Chon, H., Cikot, J.L.M., Delemarre, F.M.C., Diris, J.H.C., Doesburg-van Kleffens, M., Dooren, I.M.A. van, Duijnhoven, J.L.P. van, Dunne, F.M. van, Duvekot, J.J., Engbers, P., Hulst, M.J.W.V., Feitsma, H., Fouraux, M.A., Franssen, M.T.M., Frasa, M.A.M., Gammeren, A.J. van, Gemund, N. van, Graaf, F. van der, Groot, C.J.M. de, Hackeng, C.M., Ham, D.P. van der, Hanssen, M.J.C.P., Hasaart, T.H.M., Hendriks, H.A., Henskens, Y.M.C., Hermsen, B.B.J., Hogenboom, S., Hooker, A., Hudig, F., Huijssoon, A.M.G., Huisjes, A.J.M., Jonker, N., Kabel, P.J., Kampen, C. van, Keijzer, M.H. de, Kerkhof, D.H. van de, Keuren, J.F.W., Kleiverda, G., Klinkspoor, J.H., Koehorst, S.G.A., Kok, M., Kok, R.D., Kok, J.B. de, Koops, A., Kortlandt, W., Langenveld, J., Leers, M.P.G., Leyte, A., Mare, A. de, Martens, G.D.M., Meekers, J.H., Meir, C.A. van, Metz, G.C.H., Michielse, E.C.H.J., Mostert, L.J., Bijvank, S.W.H.N., Oostenveld, E., Osmanovic, N., Oudijk, M.A., Mirani-Oostdijk, C.P., Pampus, E.C.M. van, Papatsonis, D.N.M., Peters, R.H.M., Ponjee, G.A.E., Pontesilli, M., Porath, M.M., Post, M.S., Pouwels, J.G.J., Prinzen, L., Roelofsen, J.M.T., Rondeel, J.J.M., Salm, P.C.M. van der, Scheepers, H.C.J., Schippers, D.H., Schuitemaker, N.W.E., Sikkema, J.M., Slomp, J., Smit, J.W., Snuif-de Lange, Y.S., Stappen, J.W.J. van der, Steures, P., Tax, G.H.M., Treskes, M., Ulenkate, H.J.L.M., Unnik, G.A. van, Veen, B.S. van der, Verhagen, T.E.M., Versendaal, J., Visschers, B., Visser, O., Visser, H., Vooght, K.M.K. de, Vries, M.J. de, Waard, H. de, Weerkamp, F., Weinans, M.J.N., Wet, H. de, Wijnen, M. van, Wijngaarden, W.J. van, Wit, A.C. de, Woiski, M.D., TeMpOH-Study Grp, APH - Quality of Care, APH - Global Health, Obstetrics & Gynecology, RS: CARIM - R1.04 - Clinical thrombosis and haemostasis, MUMC+: DA CDL Algemeen (9), Faculteit FHML Centraal, RS: Carim - B04 Clinical thrombosis and Haemostasis, Reproductive Origins of Adult Health and Disease (ROAHD), and Athena Institute

Subjects
Adult, medicine.medical_specialty, Resuscitation, Blood transfusion, medicine.medical_treatment, CRYSTALLOIDS, Postpartum haemorrhage, 03 medical and health sciences, RED-BLOOD-CELLS, 0302 clinical medicine, SDG 3 - Good Health and Well-being, Interquartile range, Pregnancy, ERYTHROCYTES, medicine, Humans, Crystalloid solutions, 030212 general & internal medicine, Colloids, THROMBIN GENERATION, Netherlands, Retrospective Studies, COAGULOPATHY, 030219 obstetrics & reproductive medicine, Obstetrics, business.industry, Postpartum Hemorrhage, Obstetrics and Gynecology, Retrospective cohort study, Odds ratio, Confidence interval, Treatment Outcome, Reproductive Medicine, Fluid Therapy, TRAUMA PATIENTS, Female, Packed red blood cells, business, Cohort study
Abstract

Objective: To determine the association between increasing volumes of crystalloids and colloids administered before transfusion of packed red blood cells in women with persistent postpartum haemorrhage and adverse maternal outcomes. Study design: Retrospective cohort study in the Netherlands. Women with persistent postpartum haemorrhage and known clear fluids volume for resuscitation were included. Women who received ≤2 L of clear fluids were the reference group. We determined the effect of every additional litre of clear fluids on total blood loss, severe maternal morbidity and mortality. Results were adjusted for patient and bleeding characteristics. Results: Of the 883 included women, 199 received ≤2 L of clear fluids. Median blood loss for the reference group was 2.9 L (interquartile range 2.2–3.4). Adjusted mean difference in blood loss compared with the reference group was 0.2 L (95% confidence interval −0.1 to 0.5) for women in the >2 to ≤3 L, 0.4 L (0.1–0.7) for the >3 to ≤4 L category, 0.6 L (0.5–0.7) for the >4 to ≤5 L category, and 1.9 L (1.5–2.3) for the >5 to ≤7 L category. Adjusted odds ratios for adverse maternal outcomes were 1.0 (0.7–1.6), 1.2 (0.8–1.9), 1.8 (1.1–3.1) and 4.4 (2.6–7.5) for women in the 2 to ≤3 L category, >3 to ≤4 L, >4 to ≤5 L, and >5 to ≤7 L volume categories respectively. Results were similar in strata of different severities of bleeding. Conclusion: Clear fluids volume >4 L was independently associated with adverse maternal outcome in women with persistent postpartum haemorrhage.

Published
2019
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23. Delivery or expectant management for prevention of adverse maternal and neonatal outcomes in hypertensive disorders of pregnancy: an individual participant data meta‐analysis

Author

Bernardes, T. P., primary, Zwertbroek, E. F., additional, Broekhuijsen, K., additional, Koopmans, C., additional, Boers, K., additional, Owens, M., additional, Thornton, J., additional, van Pampus, M. G., additional, Scherjon, S. A., additional, Wallace, K., additional, Langenveld, J., additional, van den Berg, P. P., additional, Franssen, M. T. M., additional, Mol, B. W. J., additional, and Groen, H., additional

Published
2019
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24. Balloon catheter for induction of labor in women with one previous cesarean and an unfavorable cervix

Author

Huisman, C.M.A., Eikelder, M.L. Ten, Mast, K., Rengerink, K. Oude, Jozwiak, M., Dunne, F. van, Duvekot, J.J., Eyck, J. van, Gaugler-Senden, I., Groot, C.J. de, Franssen, M.T., Gemund, N. van, Langenveld, J., Leeuw, J.W. de, Lohuis, E.J. Oude, Oudijk, Martijn A., Papatsonis, D., Pampus, M. van, Porath, M., Weerd, S. Rombout-de, Roosmalen, J.J. van, Salm, P.C. van der, Scheepers, H.C., Sikkema, M.J., Sporken, J., Stigter, R.H., Wijngaarden, W.J. van, Woiski, M.D., Mol, B.W.J., Bloemenkamp, K.W., Huisman, C.M.A., Eikelder, M.L. Ten, Mast, K., Rengerink, K. Oude, Jozwiak, M., Dunne, F. van, Duvekot, J.J., Eyck, J. van, Gaugler-Senden, I., Groot, C.J. de, Franssen, M.T., Gemund, N. van, Langenveld, J., Leeuw, J.W. de, Lohuis, E.J. Oude, Oudijk, Martijn A., Papatsonis, D., Pampus, M. van, Porath, M., Weerd, S. Rombout-de, Roosmalen, J.J. van, Salm, P.C. van der, Scheepers, H.C., Sikkema, M.J., Sporken, J., Stigter, R.H., Wijngaarden, W.J. van, Woiski, M.D., Mol, B.W.J., and Bloemenkamp, K.W.

Abstract

Contains fulltext : 205398.pdf (publisher's version ) (Open Access), 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

Published
2019

25. Clinical characteristics of women captured by extending the definition of severe postpartum haemorrhage with 'refractoriness to treatment': a cohort study

Author

Henriquez, D., Gillissen, A., Smith, S.M., Cramer, R.A., van den Akker, T., Zwart, J.J. (Joost), van Roosmalen, J.J., Bloemenkamp, KW, Bom, J.G., Adriaanse, H.J., van den Akker, E.S.A., Baas, M.I., Bank, C.M.C., Beek, E. van, de Boer, B.A.G., Boer, K. (Karin), van der Borden, D.M.R., Bremer, H.A. (Henk), Brons, J.T.J., Burggraaff, J.M. (Jan), Ceelie, H., Chon, H., Cikot, J.L.M., Delemarre, F.M.C., Diris, J.H.C., Doesburg-van Kleffens, M., van Dooren, I.M.A., van Duijnhoven, J.L.P., van Dunn, F.M., Duvekot, J.J. (Hans), Engbers, P., van Hulst, M.J.W., Feitsma, H., Fouraux, M.A., Franssen, MT, Frasa, M.A.M., van Gammeren, A.J., Gemund, N. (Nicolette) van, van der Graaf, F., Groot, C.J.M., Hackeng, C.M. (Christian), Ham, D.P. (David) van der, Hanssen, M., Hasaart, T.H.M. (Tom), Hendriks, H.A., Henskens, Y.M.C., Hermsen, B.B.J., Hogenboom, S., Hooker, A., Hudig, F, Huijssoon, A.G. (Annemarie), Huisjes, A.J.M. (Anjoke), Jonker, N., Kabel, P.J., van Kampen, C., de Keijzer, M.H., van de Kerkhof, D.H., Keuren, JFW, Kleiverda, G., Klinkspoor, J.H., Koehorst, S.G.A., Kok, M.O. (Maarten), Kok, R.D., Kok, J.B. (Jacques) de, Koops, A., Kortlandt, W. (Wouter), Langenveld, J. (J.), Leers, MPG, Leyte, A. (Anja), de Mare, A., Martens, G.D.M., Meekers, J.H., Meir, C.A. (Claudia) van, Metz, G.C.H. (Godfried), Michielse, E., Mostert, L.J., Bijvank, S., Oostenveld, E., Osmanovic, N., Oudijk, M.A. (Martijn), Mirani-Oostdijk, C.P., van Pampus, E. C. M., Papatsonis, D.N.M. (Dimitri), Peters, R.H.M., Ponjee, G.A.E. (Gabriëlle), Pontesilli, M., Porath, M. (Martina), Post, M.S., Pouwels, J.G.J., Prinzen, L., Roelofsen, J.M.T., Rondeel, J.J.M., Salm, P.C.M. (Paulien) van der, Scheepers, H.C.J. (Hubertina), Schippers, D.H. (Daniela), Schuitemaker, N.W.E. (Nico), Sikkema, J.M. (J. Marko), Slomp, J. (Jennita), Smit, J.W.A. (Jan), Snuif-de Lange, Y.S., van der Stappen, J.W.J., Steures, P. (Pieternel), Tax, G.H.M., Treskes, M., Ulenkate, H., van Unnik, G.A., van der Veen, B.S., Verhagen, T.E.M., Versendaal, J. (Johan), Visschers, B., Visser, O. (Oane), de Visser, H., De Vooght, KMK, de Vries, M.J., Waard, H. (Harm) de, Weerkamp, F. (Floor), Weinans, M.J.N. (Martin), de Wet, H., Wijnen, M. (Marit), Wijngaarden, W.J. (Wim) van, de Wit, A.C., Woiski, M.D. (Mallory), TeMp, O.H.S.G., Henriquez, D., Gillissen, A., Smith, S.M., Cramer, R.A., van den Akker, T., Zwart, J.J. (Joost), van Roosmalen, J.J., Bloemenkamp, KW, Bom, J.G., Adriaanse, H.J., van den Akker, E.S.A., Baas, M.I., Bank, C.M.C., Beek, E. van, de Boer, B.A.G., Boer, K. (Karin), van der Borden, D.M.R., Bremer, H.A. (Henk), Brons, J.T.J., Burggraaff, J.M. (Jan), Ceelie, H., Chon, H., Cikot, J.L.M., Delemarre, F.M.C., Diris, J.H.C., Doesburg-van Kleffens, M., van Dooren, I.M.A., van Duijnhoven, J.L.P., van Dunn, F.M., Duvekot, J.J. (Hans), Engbers, P., van Hulst, M.J.W., Feitsma, H., Fouraux, M.A., Franssen, MT, Frasa, M.A.M., van Gammeren, A.J., Gemund, N. (Nicolette) van, van der Graaf, F., Groot, C.J.M., Hackeng, C.M. (Christian), Ham, D.P. (David) van der, Hanssen, M., Hasaart, T.H.M. (Tom), Hendriks, H.A., Henskens, Y.M.C., Hermsen, B.B.J., Hogenboom, S., Hooker, A., Hudig, F, Huijssoon, A.G. (Annemarie), Huisjes, A.J.M. (Anjoke), Jonker, N., Kabel, P.J., van Kampen, C., de Keijzer, M.H., van de Kerkhof, D.H., Keuren, JFW, Kleiverda, G., Klinkspoor, J.H., Koehorst, S.G.A., Kok, M.O. (Maarten), Kok, R.D., Kok, J.B. (Jacques) de, Koops, A., Kortlandt, W. (Wouter), Langenveld, J. (J.), Leers, MPG, Leyte, A. (Anja), de Mare, A., Martens, G.D.M., Meekers, J.H., Meir, C.A. (Claudia) van, Metz, G.C.H. (Godfried), Michielse, E., Mostert, L.J., Bijvank, S., Oostenveld, E., Osmanovic, N., Oudijk, M.A. (Martijn), Mirani-Oostdijk, C.P., van Pampus, E. C. M., Papatsonis, D.N.M. (Dimitri), Peters, R.H.M., Ponjee, G.A.E. (Gabriëlle), Pontesilli, M., Porath, M. (Martina), Post, M.S., Pouwels, J.G.J., Prinzen, L., Roelofsen, J.M.T., Rondeel, J.J.M., Salm, P.C.M. (Paulien) van der, Scheepers, H.C.J. (Hubertina), Schippers, D.H. (Daniela), Schuitemaker, N.W.E. (Nico), Sikkema, J.M. (J. Marko), Slomp, J. (Jennita), Smit, J.W.A. (Jan), Snuif-de Lange, Y.S., van der Stappen, J.W.J., Steures, P. (Pieternel), Tax, G.H.M., Treskes, M., Ulenkate, H., van Unnik, G.A., van der Veen, B.S., Verhagen, T.E.M., Versendaal, J. (Johan), Visschers, B., Visser, O. (Oane), de Visser, H., De Vooght, KMK, de Vries, M.J., Waard, H. (Harm) de, Weerkamp, F. (Floor), Weinans, M.J.N. (Martin), de Wet, H., Wijnen, M. (Marit), Wijngaarden, W.J. (Wim) van, de Wit, A.C., Woiski, M.D. (Mallory), and TeMp, O.H.S.G.

Abstract

Background: The absence of a uniform and clinically relevant definition of severe postpartum haemorrhage hampers comparative studies and optimization of clinical management. The concept of persistent postpartum haemorrhage, based on refractoriness to initial first-line treatment, was proposed as an alternative to common definitions that are either based on estimations of blood loss or transfused units of packed red blood cells (RBC). We compared characteristics and outcomes of women with severe postpartum haemorrhage captured by these three types of definitions. Methods: In this large retrospective cohort study in 61 hospitals in the Netherlands we included 1391 consecutive women with postpartum haemorrhage who received either ≥4 units of RBC or a multicomponent transfusion. Clinical characteristics and outcomes of women with severe postpartum haemorrhage defined as persistent postpartum haemorrhage were compared to definitions based on estimated blood loss or transfused units of RBC within 24 h following birth. Adverse maternal outcome was a composite of maternal mortality, hysterectomy, arterial embolisation and intensive care unit admission. Results: One thousand two hundred sixty out of 1391 women (90.6%) with postpartum haemorrhage fulfilled the definition of persistent postpartum haemorrhage. The majority, 820/1260 (65.1%), fulfilled this definition within 1 h following birth, compared to 819/1391 (58.7%) applying the definition of ≥1 L blood loss and 37/845 (4.4%) applying the definition of ≥4 units of RBC. The definition persistent postpartum haemorrhage captured 430/471 adverse maternal outcomes (91.3%), compared to 471/471 (100%) for ≥1 L blood loss and 383/471 (81.3%) for ≥4 units of RBC. Persiste

Published
2019
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26. Clinical characteristics of women captured by extending the definition of severe postpartum haemorrhage with 'refractoriness to treatment': a cohort study

Author

Henriquez, D, Gillissen, A, Smith, SM, Cramer, RA, van den Akker, T, Zwart, JJ, van Roosmalen, JJ, Bloemenkamp, KW, Bom, JG, Adriaanse, HJ, Akker, ESA, Baas, MI, Bank, CMC, Beek, E, de Boer, BAG, Boer, K, van der Borden, DMR, Bremer, HA, Brons, JTJ, Burggraaff, JM, Ceelie, H, Chon, H, Cikot, JLM, Delemarre, FMC, Diris, JHC, Doesburg-van Kleffens, M, van Dooren, IMA, van Duijnhoven, JLP, van Dunn, FM, Duvekot, J.J., Engbers, P, Hulst, MJW, Feitsma, H, Fouraux, MA, Franssen, MT, Frasa, MAM, van Gammeren, AJ, Gemund, N, Graaf, F, Groot, CJM, Hackeng, CM, van der Ham, DP, Hanssen, M, Hasaart, THM, Hendriks, HA, Henskens, YMC, Hermsen, BBJ, Hogenboom, S, Hooker, A, Hudig, F, Huijssoon, AMG, Huisjes, AJM, Jonker, N, Kabel, PJ, van Kampen, C, de Keijzer, MH, van de Kerkhof, DH, Keuren, JFW, Kleiverda, G, Klinkspoor, JH, Koehorst, SGA, Kok, M, Kok, RD, de Kok, JB, Koops, A, Kortlandt, W, Langenveld, J, Leers, MPG, Leyte, A, de Mare, A, Martens, GDM, Meekers, JH, van Meir, CA, Metz, GCH, Michielse, E, Mostert, LJ, Bijvank, S, Oostenveld, E, Osmanovic, N, Oudijk, MA, Mirani-Oostdijk, CP, van Pampus, E C M, Papatsonis, DNM, Peters, RHM, Ponjee, GA, Pontesilli, M, Porath, MM, Post, MS, Pouwels, JGJ, Prinzen, L, Roelofsen, JMT, Rondeel, JJM, van der Salm, PCM, Scheepers, HCJ, Schippers, DH, Schuitemaker, NWE, Sikkema, JM, Slomp, J, Smit, JWA, Snuif-de Lange, YS, van der Stappen, JWJ, Steures, P, Tax, GHM, Treskes, M, Ulenkate, H, van Unnik, GA, van der Veen, BS, Verhagen, TEM, Versendaal, J, Visschers, B, Visser, O, Visser, H, De Vooght, KMK, Vries, MJ, Waard, H, Weerkamp, F, Weinans, MJN, de Wet, H, Wijnen, M (Mandy), van Wijngaarden, WJ, de Wit, AC, Woiski, MD, TeMp, OHSG, Henriquez, D, Gillissen, A, Smith, SM, Cramer, RA, van den Akker, T, Zwart, JJ, van Roosmalen, JJ, Bloemenkamp, KW, Bom, JG, Adriaanse, HJ, Akker, ESA, Baas, MI, Bank, CMC, Beek, E, de Boer, BAG, Boer, K, van der Borden, DMR, Bremer, HA, Brons, JTJ, Burggraaff, JM, Ceelie, H, Chon, H, Cikot, JLM, Delemarre, FMC, Diris, JHC, Doesburg-van Kleffens, M, van Dooren, IMA, van Duijnhoven, JLP, van Dunn, FM, Duvekot, J.J., Engbers, P, Hulst, MJW, Feitsma, H, Fouraux, MA, Franssen, MT, Frasa, MAM, van Gammeren, AJ, Gemund, N, Graaf, F, Groot, CJM, Hackeng, CM, van der Ham, DP, Hanssen, M, Hasaart, THM, Hendriks, HA, Henskens, YMC, Hermsen, BBJ, Hogenboom, S, Hooker, A, Hudig, F, Huijssoon, AMG, Huisjes, AJM, Jonker, N, Kabel, PJ, van Kampen, C, de Keijzer, MH, van de Kerkhof, DH, Keuren, JFW, Kleiverda, G, Klinkspoor, JH, Koehorst, SGA, Kok, M, Kok, RD, de Kok, JB, Koops, A, Kortlandt, W, Langenveld, J, Leers, MPG, Leyte, A, de Mare, A, Martens, GDM, Meekers, JH, van Meir, CA, Metz, GCH, Michielse, E, Mostert, LJ, Bijvank, S, Oostenveld, E, Osmanovic, N, Oudijk, MA, Mirani-Oostdijk, CP, van Pampus, E C M, Papatsonis, DNM, Peters, RHM, Ponjee, GA, Pontesilli, M, Porath, MM, Post, MS, Pouwels, JGJ, Prinzen, L, Roelofsen, JMT, Rondeel, JJM, van der Salm, PCM, Scheepers, HCJ, Schippers, DH, Schuitemaker, NWE, Sikkema, JM, Slomp, J, Smit, JWA, Snuif-de Lange, YS, van der Stappen, JWJ, Steures, P, Tax, GHM, Treskes, M, Ulenkate, H, van Unnik, GA, van der Veen, BS, Verhagen, TEM, Versendaal, J, Visschers, B, Visser, O, Visser, H, De Vooght, KMK, Vries, MJ, Waard, H, Weerkamp, F, Weinans, MJN, de Wet, H, Wijnen, M (Mandy), van Wijngaarden, WJ, de Wit, AC, Woiski, MD, and TeMp, OHSG

Published
2019

27. Balloon catheter for induction of labor in women with one previous cesarean and an unfavorable cervix

Author

Huisman, CMA, ten Eikelder, MLG, Mast, K, Rengerink, KO, Jozwiak, M, Dunne, F, Duvekot, J.J., Eyck, J, Gaugler-Senden, I, Groot, CJM, Franssen, MTM, Gemund, Nicolette, Langenveld, J, Leeuw, JW, Lohuis, EJO, Oudijk, MA, Papatsonis, D, van Pampus, M, Porath, M, 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 (Ben), Bloemenkamp, KWM, Huisman, CMA, ten Eikelder, MLG, Mast, K, Rengerink, KO, Jozwiak, M, Dunne, F, Duvekot, J.J., Eyck, J, Gaugler-Senden, I, Groot, CJM, Franssen, MTM, Gemund, Nicolette, Langenveld, J, Leeuw, JW, Lohuis, EJO, Oudijk, MA, Papatsonis, D, van Pampus, M, Porath, M, 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 (Ben), and Bloemenkamp, KWM

Published
2019

28. Single- versus double-layer closure of the caesarean (uterine) scar in the prevention of gynaecological symptoms in relation to niche development - the 2Close study: a multicentre randomised controlled trial

Author

Arts-assistenten Kinderen, Orthopaedie Opleiding, Regenerative Medicine and Stem Cells, MS Reumatologie/Immunologie/Infectie, Infection & Immunity, MS Verloskunde, Child Health, Arts-assistenten DV&B, Stegwee, S I, Jordans, I P M, van der Voet, L F, Bongers, M Y, de Groot, C J M, Lambalk, C B, de Leeuw, R A, Hehenkamp, W J K, van de Ven, P M, Bosmans, J E, Pajkrt, E, Bakkum, E A, Radder, C M, Hemelaar, M, van Baal, W M, Visser, H, van Laar, J O E H, van Vliet, H A A M, Rijnders, R J P, Sueters, M, Janssen, C A H, Hermes, W, Feitsma, A H, Kapiteijn, K, Scheepers, H C J, Langenveld, J, de Boer, K, Coppus, S F P J, Schippers, D H, Oei, A L M, Kaplan, M, Papatsonis, D N M, de Vleeschouwer, L H M, van Beek, E, Bekker, M N, Huisjes, A J M, Meijer, W J, Deurloo, K L, Boormans, E M A, van Eijndhoven, H W F, Huirne, J A F, Arts-assistenten Kinderen, Orthopaedie Opleiding, Regenerative Medicine and Stem Cells, MS Reumatologie/Immunologie/Infectie, Infection & Immunity, MS Verloskunde, Child Health, Arts-assistenten DV&B, Stegwee, S I, Jordans, I P M, van der Voet, L F, Bongers, M Y, de Groot, C J M, Lambalk, C B, de Leeuw, R A, Hehenkamp, W J K, van de Ven, P M, Bosmans, J E, Pajkrt, E, Bakkum, E A, Radder, C M, Hemelaar, M, van Baal, W M, Visser, H, van Laar, J O E H, van Vliet, H A A M, Rijnders, R J P, Sueters, M, Janssen, C A H, Hermes, W, Feitsma, A H, Kapiteijn, K, Scheepers, H C J, Langenveld, J, de Boer, K, Coppus, S F P J, Schippers, D H, Oei, A L M, Kaplan, M, Papatsonis, D N M, de Vleeschouwer, L H M, van Beek, E, Bekker, M N, Huisjes, A J M, Meijer, W J, Deurloo, K L, Boormans, E M A, van Eijndhoven, H W F, and Huirne, J A F

Published
2019

30. Restrictive Versus Massive Fluid Resuscitation Strategy (REFILL study), influence on blood loss and hemostatic parameters in obstetric hemorrhage: study protocol for a randomized controlled trial

Author

Lange, N.M. de, Schol, Pim, Lance, M., Woiski, M.D., Langenveld, J., Rijnders, R., Henskens, Y.M., Scheepers, H., Lange, N.M. de, Schol, Pim, Lance, M., Woiski, M.D., Langenveld, J., Rijnders, R., Henskens, Y.M., and Scheepers, H.

Abstract

Contains fulltext : 190075.pdf (publisher's version ) (Open Access)

Published
2018

31. Continuous glucose monitoring during diabetic pregnancy (GlucoMOMS): A multicentre randomized controlled trial

Author

Voormolen, D.N., DeVries, J.H., Sanson, R.M.E., Heringa, M.P., Valk, H.W. de, Kok, M., Loon, A.J. van, Hoogenberg, K., Bekedam, D.J., Brouwer, T.C.B., Porath, M., Erdtsieck, R.J., NijBijvank, B., Kip, H., Heijden, O.W.H. van der, Elving, L.D., Hermsen, B.B., Loon, B.J. Potter van, Rijnders, R.J., Jansen, H.J., Langenveld, J., Akerboom, B.M., Kiewiet, R.M., Naaktgeboren, C.A., Mol, B.W.J., Franx, A., Evers, I.M., Voormolen, D.N., DeVries, J.H., Sanson, R.M.E., Heringa, M.P., Valk, H.W. de, Kok, M., Loon, A.J. van, Hoogenberg, K., Bekedam, D.J., Brouwer, T.C.B., Porath, M., Erdtsieck, R.J., NijBijvank, B., Kip, H., Heijden, O.W.H. van der, Elving, L.D., Hermsen, B.B., Loon, B.J. Potter van, Rijnders, R.J., Jansen, H.J., Langenveld, J., Akerboom, B.M., Kiewiet, R.M., Naaktgeboren, C.A., Mol, B.W.J., Franx, A., and Evers, I.M.

Abstract

Contains fulltext : 198097.pdf (publisher's version ) (Closed access), AIM: Diabetes is associated with a high risk of adverse pregnancy outcomes. Optimal glycaemic control is fundamental and is traditionally monitored with self-measured glucose profiles and periodic HbA1c measurements. We investigated the effectiveness of additional use of retrospective continuous glucose monitoring (CGM) in diabetic pregnancies. MATERIAL AND METHODS: We performed a nationwide multicentre, open label, randomized, controlled trial to study pregnant women with type 1 or type 2 diabetes who were undergoing insulin therapy at gestational age < 16 weeks, or women who were undergoing insulin treatment for gestational diabetes at gestational age < 30 weeks. Women were randomly allocated (1:1) to intermittent use of retrospective CGM or to standard treatment. Glycaemic control was assessed by CGM for 5-7 days every 6 weeks in the CGM group, while self-monitoring of blood glucose and HbA1c measurements were applied in both groups. Primary outcome was macrosomia, defined as birth weight above the 90th percentile. Secondary outcomes were glycaemic control and maternal and neonatal complications. RESULTS: Between July 2011 and September 2015, we randomized 300 pregnant women with type 1 (n = 109), type 2 (n = 82) or with gestational (n = 109) diabetes to either CGM (n = 147) or standard treatment (n = 153). The incidence of macrosomia was 31.0% in the CGM group and 28.4% in the standard treatment group (relative risk [RR], 1.06; 95% CI, 0.83-1.37). HbA1c levels were similar between treatment groups. CONCLUSIONS: In diabetic pregnancy, use of intermittent retrospective CGM did not reduce the risk of macrosomia. CGM provides detailed information concerning glycaemic fluctuations but, as a treatment strategy, does not translate into improved pregnancy outcome.

Published
2018

32. An economic analysis of immediate delivery and expectant monitoring in women with hypertensive disorders of pregnancy, between 34 and 37 weeks of gestation (HYPITAT-II)

Author

van Baaren, G.J., Broekhuijsen, K, Pampus, M.G., Ganzevoort, W., Sikkema, J Marko, Woiski, Mallory D, Oudijk, M. A., Bloemenkamp, K. W.M., Scheepers, Hubertina C. J., Bremer, Henk A, Rijnders, Robbert J. P., van Loon, A. J., Perquin, Denise A M, Sporken, Jan M J, Papatsonis, D N M, van Huizen, M E, Vredevoogd, C B, Brons, Jozien T J, Kaplan, M., van Kaam, Anton H., Groen, H., Porath, M., van den Berg, P., Mol, B. W J, Franssen, Maureen T. M., Langenveld, J, and the HYPITAT-II Study Group

Subjects
immediate delivery, expectant monitoring, Obstetrics and Gynaecology, Journal Article, preterm, Economic evaluation, hypertensive disorders
Abstract

Objective: To assess the economic consequences of immediate delivery compared with expectant monitoring in women with preterm non-severe hypertensive disorders of pregnancy. Design: A cost-effectiveness analysis alongside a randomised controlled trial (HYPITAT-II). Setting: Obstetric departments of seven academic hospitals and 44 non-academic hospitals in the Netherlands. Population: Women diagnosed with non-severe hypertensive disorders of pregnancy between 340/7 and 370/7 weeks of gestation, randomly allocated to either immediate delivery or expectant monitoring. Methods: A trial-based cost-effectiveness analysis was performed from a healthcare perspective until final maternal and neonatal discharge. Main outcome measures: Health outcomes were expressed as the prevalence of respiratory distress syndrome, defined as the need for supplemental oxygen for >24 hours combined with radiographic findings typical for respiratory distress syndrome. Costs were estimated from a healthcare perspective until maternal and neonatal discharge. Results: The average costs of immediate delivery (n = 352) were €10 245 versus €9563 for expectant monitoring (n = 351), with an average difference of €682 (95% confidence interval, 95% CI −€618 to €2126). This 7% difference predominantly originated from the neonatal admissions, which were €5672 in the immediate delivery arm and €3929 in the expectant monitoring arm. Conclusion: In women with mild hypertensive disorders between 340/7 and 370/7 weeks of gestation, immediate delivery is more costly than expectant monitoring as a result of differences in neonatal admissions. These findings support expectant monitoring, as the clinical outcomes of the trial demonstrated that expectant monitoring reduced respiratory distress syndrome for a slightly increased risk of maternal complications. Tweetable abstract: Expectant management in preterm hypertensive disorders is less costly compared with immediate delivery.

Published
2017

33. MisoREST : surgical versus expectant management in women with an incomplete evacuation of the uterus after misoprostol treatment for miscarriage: a randomized controlled trial

Author

Lemmers, M, Verschoor, M A C, Oude Rengerink, K, Naaktgeboren, C, Opmeer, B C, Bossuyt, P M, Huirne, J A F, Janssen, C A H, Radder, C, Klinkert, E R, Langenveld, J, Catshoek, R, Van der Voet, L, Siemens, F, Geomini, P, Van Hooff, M H, Van der Ploeg, J M, Coppus, S F P J, Ankum, W M, Mol, B W J, and MisoREST study group

Subjects
surgery, uterus, miscarriage, Journal Article, abortion, expectant management
Abstract

STUDY QUESTION: Is curettage more effective than expectant management in case of an incomplete evacuation after misoprostol treatment for first trimester miscarriage? SUMMARY ANSWER: Curettage leads to a higher chance of complete evacuation but expectant management is successful in at least 76% of women with an incomplete evacuation of the uterus after misoprostol treatment for first trimester miscarriage. WHAT IS KNOWN ALREADY: In 5-50% of the women treated with misoprostol, there is a suspicion of incomplete evacuation of the uterus on sonography. Although these women generally have minor symptoms, such a finding often leads to additional curettage. STUDY DESIGN, SIZE, DURATION: From June 2012 until July 2014, we conducted a nationwide multicenter randomized controlled trial (RCT). Women who had had primary misoprostol treatment for miscarriage with sonographic evidence of incomplete evacuation of the uterus were randomly allocated to either curettage or expectant management (1:1), using a web-based application. PARTICIPANTS/MATERIALS, SETTING, METHODS: We included 59 women in 27 hospitals; 30 were allocated to curettage and 29 were allocated to expectant management. A successful outcome was defined as sonographic finding of an empty uterus 6 weeks after randomization. MAIN RESULTS AND THE ROLE OF CHANCE: Baseline characteristics of both groups were comparable. Empty uterus on sonography or uneventful clinical follow-up was seen in 29/30 women (97%) allocated to curettage compared with 22/29 women (76%) allocated to expectant management (RR 1.3, 95% CI 1.03-1.6) with complication rates of 10% versus 10%, respectively (RR 0.97, 95% CI 0.21-4.4). In the group allocated to curettage, no woman required re-curettage, while two women (6.7%) underwent hysteroscopy (for other or unknown reasons). In the women allocated to expectant management, curettage was performed in four women (13.8%) and three women (10.3%) underwent hysteroscopy. LIMITATIONS, REASONS FOR CAUTION: Due to a strong patient preference, mainly for expectant management, the targeted sample size could not be included and the trial was stopped prematurely. WIDER IMPLICATIONS OF THE FINDINGS: In women suspected of incomplete evacuation of the uterus after misoprostol, curettage is more effective than expectant management. However, expectant management is equally safe and prevents curettage for most of the women. This finding could further restrain the use of curettage in the treatment of first trimester miscarriage. STUDY FUNDING/COMPETING INTERESTS: This study was funded by ZonMw, a Dutch organization for Health Research and Development, project number 80-82310-97-12066. There were no conflicts of interests. TRIAL REGISTRATION NUMBER: Dutch Trial Register NTR3310, http://www.trialregister.nl TRIAL REGISTRATION DATE: 27 February 2012. DATE OF FIRST PATIENT'S ENROLMENT: 12 June 2012.

Published
2016

35. Pessary or Progesterone to Prevent Preterm delivery in women with short cervical length: the Quadruple P randomised controlled trial

Author

Zijl, M.D. van, Koullali, B., Naaktgeboren, C.A., Schuit, E., Bekedam, D.J., Moll, E., Oudijk, M.A., Baal, W.M. van, Boer, M.A. de, Visser, H., Drongelen, J. van, Made, F.W. van de, Vollebregt, K.C., Muller, M.A., Bekker, M.N., Brons, J.T., Sueters, M., Langenveld, J., Franssen, M.T., Schuitemaker, N.W., Beek, E. van, Scheepers, H.C., Boer, K. de, Tepe, E.M., Huisjes, A.J., Hooker, A.B., Verheijen, E.C.J., Papatsonis, D.N., Mol, B.W., Kazemier, B.M., Pajkrt, E., Zijl, M.D. van, Koullali, B., Naaktgeboren, C.A., Schuit, E., Bekedam, D.J., Moll, E., Oudijk, M.A., Baal, W.M. van, Boer, M.A. de, Visser, H., Drongelen, J. van, Made, F.W. van de, Vollebregt, K.C., Muller, M.A., Bekker, M.N., Brons, J.T., Sueters, M., Langenveld, J., Franssen, M.T., Schuitemaker, N.W., Beek, E. van, Scheepers, H.C., Boer, K. de, Tepe, E.M., Huisjes, A.J., Hooker, A.B., Verheijen, E.C.J., Papatsonis, D.N., Mol, B.W., Kazemier, B.M., and Pajkrt, E.

Abstract

Contains fulltext : 177872.pdf (publisher's version ) (Open Access), BACKGROUND: Preterm birth is in quantity and in severity the most important topic in obstetric care in the developed world. Progestogens and cervical pessaries have been studied as potential preventive treatments with conflicting results. So far, no study has compared both treatments. METHODS/DESIGN: The Quadruple P study aims to compare the efficacy of vaginal progesterone and cervical pessary in the prevention of adverse perinatal outcome associated with preterm birth in asymptomatic women with a short cervix, in singleton and multiple pregnancies separately. It is a nationwide open-label multicentre randomized clinical trial (RCT) with a superiority design and will be accompanied by an economic analysis. Pregnant women undergoing the routine anomaly scan will be offered cervical length measurement between 18 and 22 weeks in a singleton and at 16-22 weeks in a multiple pregnancy. Women with a short cervix, defined as less than, or equal to 35 mm in a singleton and less than 38 mm in a multiple pregnancy, will be invited to participate in the study. Eligible women will be randomly allocated to receive either progesterone or a cervical pessary. Following randomization, the silicone cervical pessary will be placed during vaginal examination or 200 mg progesterone capsules will be daily self-administered vaginally. Both interventions will be continued until 36 weeks gestation or until delivery, whichever comes first. Primary outcome will be composite adverse perinatal outcome of perinatal mortality and perinatal morbidity including bronchopulmonary dysplasia, intraventricular haemorrhage grade III and IV, periventricular leukomalacia higher than grade I, necrotizing enterocolitis higher than stage I, Retinopathy of prematurity (ROP) or culture proven sepsis. These outcomes will be measured up until 10 weeks after the expected due date. Secondary outcomes will be, among others, time to delivery, preterm birth rate before 28, 32, 34 and 37 weeks, admission to neonatal i

Published
2017

36. An economic analysis of immediate delivery and expectant monitoring in women with hypertensive disorders of pregnancy, between 34 and 37 weeks of gestation (HYPITAT-II)

Author

Baaren, G.J. van, Broekhuijsen, K., Pampus, M.G. van, Ganzevoort, W., Sikkema, J.M., Woiski, M.D., Oudijk, M.A., Bloemenkamp, K., Scheepers, H., Bremer, H.A., Rijnders, R., Loon, A.J. van, Perquin, D., Sporken, J., Papatsonis, D., Huizen, M.E. van, Vredevoogd, C.B., Brons, J., Kaplan, M., Kaam, A.H. van, Groen, H., Porath, M., Berg, P.P. van den, Mol, B., Franssen, M., Langenveld, J., Baaren, G.J. van, Broekhuijsen, K., Pampus, M.G. van, Ganzevoort, W., Sikkema, J.M., Woiski, M.D., Oudijk, M.A., Bloemenkamp, K., Scheepers, H., Bremer, H.A., Rijnders, R., Loon, A.J. van, Perquin, D., Sporken, J., Papatsonis, D., Huizen, M.E. van, Vredevoogd, C.B., Brons, J., Kaplan, M., Kaam, A.H. van, Groen, H., Porath, M., Berg, P.P. van den, Mol, B., Franssen, M., and Langenveld, J.

Abstract

Item does not contain fulltext, OBJECTIVE: To assess the economic consequences of immediate delivery compared with expectant monitoring in women with preterm non-severe hypertensive disorders of pregnancy. DESIGN: A cost-effectiveness analysis alongside a randomised controlled trial (HYPITAT-II). SETTING: Obstetric departments of seven academic hospitals and 44 non-academic hospitals in the Netherlands. POPULATION: Women diagnosed with non-severe hypertensive disorders of pregnancy between 340/7 and 370/7 weeks of gestation, randomly allocated to either immediate delivery or expectant monitoring. METHODS: A trial-based cost-effectiveness analysis was performed from a healthcare perspective until final maternal and neonatal discharge. MAIN OUTCOME MEASURES: Health outcomes were expressed as the prevalence of respiratory distress syndrome, defined as the need for supplemental oxygen for >24 hours combined with radiographic findings typical for respiratory distress syndrome. Costs were estimated from a healthcare perspective until maternal and neonatal discharge. RESULTS: The average costs of immediate delivery (n = 352) were euro10 245 versus euro9563 for expectant monitoring (n = 351), with an average difference of euro682 (95% confidence interval, 95% CI -euro618 to euro2126). This 7% difference predominantly originated from the neonatal admissions, which were euro5672 in the immediate delivery arm and euro3929 in the expectant monitoring arm. CONCLUSION: In women with mild hypertensive disorders between 340/7 and 370/7 weeks of gestation, immediate delivery is more costly than expectant monitoring as a result of differences in neonatal admissions. These findings support expectant monitoring, as the clinical outcomes of the trial demonstrated that expectant monitoring reduced respiratory distress syndrome for a slightly increased risk of maternal complications. TWEETABLE ABSTRACT: Expectant management in preterm hypertensive disorders is less costly compared with immediate delivery.

Published
2017

37. Early enteral tube feeding in optimizing treatment of hyperemesis gravidarum: the Maternal and Offspring outcomes after Treatment of HyperEmesis by Refeeding (MOTHER) randomized controlled trial

Author

Grooten, I.J., Koot, M.H., Post, J.A. van der, Bais, J.M., Ris-Stalpers, C., Naaktgeboren, C., Bremer, H.A., Ham, D.P. van der, Heidema, W.M., Huisjes, A., Kleiverda, G., Kuppens, S., Laar, J.O.E.H. van, Langenveld, J., Made, F. van der, Pampus, M.G. van, Papatsonis, D., Pelinck, M.J., Pernet, P.J., Rheenen, L. van, Rijnders, R.J., Scheepers, H.C., Vogelvang, T.E., Mol, B.W., Roseboom, T.J., Painter, R.C., Grooten, I.J., Koot, M.H., Post, J.A. van der, Bais, J.M., Ris-Stalpers, C., Naaktgeboren, C., Bremer, H.A., Ham, D.P. van der, Heidema, W.M., Huisjes, A., Kleiverda, G., Kuppens, S., Laar, J.O.E.H. van, Langenveld, J., Made, F. van der, Pampus, M.G. van, Papatsonis, D., Pelinck, M.J., Pernet, P.J., Rheenen, L. van, Rijnders, R.J., Scheepers, H.C., Vogelvang, T.E., Mol, B.W., Roseboom, T.J., and Painter, R.C.

Abstract

Item does not contain fulltext, Background: Hyperemesis gravidarum (HG) leads to dehydration, poor nutritional intake, and weight loss. HG has been associated with adverse pregnancy outcomes such as low birth weight. Information about the potential effectiveness of treatments for HG is limited.Objective: We hypothesized that in women with HG, early enteral tube feeding in addition to standard care improves birth weight.Design: We performed a multicenter, open-label randomized controlled trial [Maternal and Offspring outcomes after Treatment of HyperEmesis by Refeeding (MOTHER)] in 19 hospitals in the Netherlands. A total of 116 women hospitalized for HG between 5 and 20 wk of gestation were randomly allocated to enteral tube feeding for >/=7 d in addition to standard care with intravenous rehydration and antiemetic treatment or to standard care alone. Women were encouraged to continue tube feeding at home. On the basis of our power calculation, a sample size of 120 women was anticipated. Analyses were performed according to the intention-to-treat principle.Results: Between October 2014 and March 2016 we randomly allocated 59 women to enteral tube feeding and 57 women to standard care. The mean +/- SD birth weight was 3160 +/- 770 g in the enteral tube feeding group compared with 3200 +/- 680 g in the standard care group (mean difference: -40 g, 95% CI: -230, 310 g). Secondary outcomes, including maternal weight gain, duration of hospital stay, readmission rate, nausea and vomiting symptoms, decrease in quality of life, psychological distress, prematurity, and small-for-gestational-age, also were comparable. Of the women allocated to enteral tube feeding, 28 (47%) were treated according to protocol. Enteral tube feeding was discontinued within 7 d of placement in the remaining women, primarily because of its adverse effects (34%).Conclusions: In women with HG, early enteral tube feeding does not improve birth weight or secondary outcomes. Many women discontinued tube feeding because of discomfort

Published
2017

38. Early enteral tube feeding in optimizing treatment of hyperemesis gravidarum: The Maternal and Offspring outcomes after Treatment of HyperEmesis by Refeeding (MOTHER) randomized controlled trial

Author

Grooten, I.J. (Iris J.), Koot, M.H. (Marjette H.), Post, J.A.M. (Joris) van der, Bais, A.G. (Aagje), Ris-stalpers, C. (Carrie), Naaktgeboren, C. (Christiana), Bremer, H.A. (Henk), Ham, D.P. (David) van der, Heidema, W.M. (Wieteke M.), Huisjes, A. (Anjoke), Kleiverda, G. (Gunilla), Kuppens, A.H. (An), Van Laar, J.O.E.H. (Judith O.E.H.), Langenveld, J. (Josje), Van Der Made, F. (Flip), Pampus, M. (Mariëlle) van, Papatsonis, D.N.M. (Dimitri), Pelinck, M.-J. (Marie-José), Pernet, P.J.M. (Paula), Van Rheenen, L. (Leonie), Rijnders, R.J.P. (Robbert), Scheepers, H.C.J. (Hubertina), Vogelvang, T.E. (Tatjana E.), Mol, B.W.J. (Ben), Roseboom, T.J. (Tessa), Painter, R.C. (Rebecca C.), Grooten, I.J. (Iris J.), Koot, M.H. (Marjette H.), Post, J.A.M. (Joris) van der, Bais, A.G. (Aagje), Ris-stalpers, C. (Carrie), Naaktgeboren, C. (Christiana), Bremer, H.A. (Henk), Ham, D.P. (David) van der, Heidema, W.M. (Wieteke M.), Huisjes, A. (Anjoke), Kleiverda, G. (Gunilla), Kuppens, A.H. (An), Van Laar, J.O.E.H. (Judith O.E.H.), Langenveld, J. (Josje), Van Der Made, F. (Flip), Pampus, M. (Mariëlle) van, Papatsonis, D.N.M. (Dimitri), Pelinck, M.-J. (Marie-José), Pernet, P.J.M. (Paula), Van Rheenen, L. (Leonie), Rijnders, R.J.P. (Robbert), Scheepers, H.C.J. (Hubertina), Vogelvang, T.E. (Tatjana E.), Mol, B.W.J. (Ben), Roseboom, T.J. (Tessa), and Painter, R.C. (Rebecca C.)

Abstract

Background: Hyperemesis gravidarum (HG) leads to dehydration, poor nutritional intake, and weight loss. HG has been associated with adverse pregnancy outcomes such as low birth weight. Information about the potential effectiveness of treatments for HG is limited. Objective: We hypothesized that in women with HG, early enteral tube feeding in addition to standard care improves birth weight. Design: We performed a multicenter, open-label randomized controlled trial [Maternal and Offspring outcomes after Treatment of HyperEmesis by Refeeding (MOTHER)] in 19 hospitals in the Netherlands. A total of 116 women hospitalized for HG between 5 and 20 wk of gestation were randomly allocated to enteral tube feeding for ≥7 d in addition to standard care with intravenous rehydration and antiemetic treatment or to standard care alone. Women were encouraged to continue tube feeding at home. On the basis of our power calculation, a sample size of 120 women was anticipated. Analyses were performed according to the intention-to-treat principle. Results: Between October 2014 and March 2016 we randomly allocated 59 women to enteral tube feeding and 57 women to standard care. The mean ± SD birth weight was 3160 ± 770 g in the enteral tube feeding group compared with 3200 ± 680 g in the standard care group (mean difference: -40 g, 95% CI: -230, 310 g). Secondary outcomes, including maternal weight gain, duration of hospital stay, readmission rate, nausea and vomiting symptoms, decrease in quality of life, psychological distress, prematurity, and small-for-gestationalage, also were comparable. Of the women allocated to enteral tube feeding, 28 (47%) were treated according to protocol. Enteral tube feeding was discontinued within 7 d of placement in the remaining women, primarily because of its adverse effects (34%). Conclusions: In women with HG, early enteral tube feeding does not improve birth weight or secondary outcomes. Many women discontinued tube feeding because of discomfort, sugge

Published
2017
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39. Practice variation of vaginal birth after cesarean and the influence of risk factors at patient level: a retrospective cohort study

Author

Vankan, E., Schoorel, E.N., Kuijk, S.M. van, Mol, B.J., Nijhuis, J.G., Aardenburg, R., Alink, M., Boer, K. de, Delemarre, F.M., Dirksen, C.D., Dooren, I.M. van, Franssen, M.T., Kaplan, M., Kleiverda, G., Kuppens, S.M., Kwee, A., Langenveld, J., Lim, F.T., Melman, S., Sikkema, M.J., Smits, L.J, Visser, H., Woiski, M.D., Scheepers, H.C., Hermens, R.P.M.G., Vankan, E., Schoorel, E.N., Kuijk, S.M. van, Mol, B.J., Nijhuis, J.G., Aardenburg, R., Alink, M., Boer, K. de, Delemarre, F.M., Dirksen, C.D., Dooren, I.M. van, Franssen, M.T., Kaplan, M., Kleiverda, G., Kuppens, S.M., Kwee, A., Langenveld, J., Lim, F.T., Melman, S., Sikkema, M.J., Smits, L.J, Visser, H., Woiski, M.D., Scheepers, H.C., and Hermens, R.P.M.G.

Abstract

Contains fulltext : 174756.pdf (publisher's version ) (Closed access), INTRODUCTION: Large practice variation exists in mode of delivery after cesarean section, suggesting variation in implementation of contemporary guidelines. We aim to evaluate this practice variation and to what extent this can be explained by risk factors at patient level. MATERIAL AND METHODS: This retrospective cohort study was performed among 17 Dutch hospitals in 2010. Women with one prior cesarean section without a contraindication for a trial of labor were included. We used multivariate logistic regression analysis to develop models for risk factor adjustments. One model was derived to adjust the elective repeat cesarean section rates; a second model to adjust vaginal birth after cesarean rates. Standardized rates of elective repeat cesarean section and vaginal birth after cesarean per hospital were compared. Pseudo-R2 measures were calculated to estimate the percentage of practice variation explained by the models. Secondary outcomes were differences in practice variation between hospital types and the correlation between standardized elective repeat cesarean section and vaginal birth after cesarean rates. RESULTS: In all, 1068 women had a history of cesarean section, of whom 71% were eligible for inclusion. A total of 515 women (67%) had a trial of labor, of whom 72% delivered vaginally. The elective repeat cesarean section rate at hospital level ranged from 6 to 54% (mean 29.8, standard deviation 11.8%). Vaginal birth after cesarean rates ranged from 50 to 90% (mean 71.8%, standard deviation 11.1%). More than 85% of this practice variation could not be explained by risk factors at patient level. CONCLUSION: A large practice variation exists in elective repeat cesarean section and vaginal birth after cesarean rates that can only partially be explained by risk factors at patient level.

Published
2017

40. MisoREST: Surgical versus expectant management in women with an incomplete evacuation of the uterus after misoprostol treatment for miscarriage: A cohort study

Author

Lemmers, M., Verschoor, M.A., Oude Rengerink, K., Naaktgeboren, C., Bossuyt, P.M., Huirne, J.A., Janssen, I.A.W., Radder, C., Klinkert, E.R., Langenveld, J., Voet, L. Van der, Siemens, F.F., Bongers, M.Y., Hooff, M.H. van, Ploeg, M., Coppus, S.F.P.J., Ankum, W.M., Mol, B.W., Lemmers, M., Verschoor, M.A., Oude Rengerink, K., Naaktgeboren, C., Bossuyt, P.M., Huirne, J.A., Janssen, I.A.W., Radder, C., Klinkert, E.R., Langenveld, J., Voet, L. Van der, Siemens, F.F., Bongers, M.Y., Hooff, M.H. van, Ploeg, M., Coppus, S.F.P.J., Ankum, W.M., and Mol, B.W.

Abstract

Item does not contain fulltext, OBJECTIVE: To assess the effectiveness of curettage versus expectant management in women with an incomplete evacuation of the uterus after misoprostol treatment for first trimester miscarriage. STUDY DESIGN: We conducted a multicenter cohort study alongside a randomized clinical trial (RCT) between June 2012 until July 2014. 27 Dutch hospitals participated. Women with an incomplete evacuation after misoprostol treatment for first trimester miscarriage who declined to participate in the RCT, received treatment of their preference; curettage (n=65) or expectant management (n=132). A successful outcome was defined as an empty uterus on sonography at six weeks or uneventful clinical follow-up. We furthermore assessed complication rate and (re)intervention rate RESULTS: Of the 197 women who declined to participate in the RCT, 65 preferred curettage and 132 expectant management. A successful outcome was observed in 62/65 women (95%) in the surgical group versus 112/132 women (85%) in the expectant group (RR 1.1, 95% CI 1.03-1.2), with complication rates of 6.2% versus 2.3%, respectively (RR 2.7, 95% CI 0.6-12). CONCLUSION: In women with an incomplete evacuation of the uterus after misoprostol treatment, expectant management is an effective and safe option. This finding could restrain the use of curettage in women that have used misoprostol in the treatment of first trimester miscarriage.

Published
2017

41. An economic analysis of immediate delivery and expectant monitoring in women with hypertensive disorders of pregnancy, between 34 and 37 weeks of gestation (HYPITAT-II)

Author

Geboortecentrum voorzitterschap, van Baaren, G.J., Broekhuijsen, K, Pampus, M.G., Ganzevoort, W., Sikkema, J Marko, Woiski, Mallory D, Oudijk, M. A., Bloemenkamp, K. W.M., Scheepers, Hubertina C. J., Bremer, Henk A, Rijnders, Robbert J. P., van Loon, A. J., Perquin, Denise A M, Sporken, Jan M J, Papatsonis, D N M, van Huizen, M E, Vredevoogd, C B, Brons, Jozien T J, Kaplan, M., van Kaam, Anton H., Groen, H., Porath, M., van den Berg, P., Mol, B. W J, Franssen, Maureen T. M., Langenveld, J, the HYPITAT-II Study Group, Geboortecentrum voorzitterschap, van Baaren, G.J., Broekhuijsen, K, Pampus, M.G., Ganzevoort, W., Sikkema, J Marko, Woiski, Mallory D, Oudijk, M. A., Bloemenkamp, K. W.M., Scheepers, Hubertina C. J., Bremer, Henk A, Rijnders, Robbert J. P., van Loon, A. J., Perquin, Denise A M, Sporken, Jan M J, Papatsonis, D N M, van Huizen, M E, Vredevoogd, C B, Brons, Jozien T J, Kaplan, M., van Kaam, Anton H., Groen, H., Porath, M., van den Berg, P., Mol, B. W J, Franssen, Maureen T. M., Langenveld, J, and the HYPITAT-II Study Group

Published
2017

42. MisoREST: surgical versus expectant management in women with an incomplete evacuation of the uterus after misoprostol treatment for miscarriage: a randomized controlled trial

Author

Lemmers, M., Verschoor, M.A., Oude Rengerink, K., Naaktgeboren, C., Opmeer, B.C., Bossuyt, P.M., Huirne, J.A., Janssen, C.A.H., Radder, C., Klinkert, E.R., Langenveld, J., Catshoek, R., Voet, L. Van der, Siemens, F., Geomini, P., Hooff, M.H. van, Ploeg, J.M. van der, Coppus, S.F.P.J., Ankum, W.M., Mol, B.W., Lemmers, M., Verschoor, M.A., Oude Rengerink, K., Naaktgeboren, C., Opmeer, B.C., Bossuyt, P.M., Huirne, J.A., Janssen, C.A.H., Radder, C., Klinkert, E.R., Langenveld, J., Catshoek, R., Voet, L. Van der, Siemens, F., Geomini, P., Hooff, M.H. van, Ploeg, J.M. van der, Coppus, S.F.P.J., Ankum, W.M., and Mol, B.W.

Abstract

Item does not contain fulltext, STUDY QUESTION: Is curettage more effective than expectant management in case of an incomplete evacuation after misoprostol treatment for first trimester miscarriage? SUMMARY ANSWER: Curettage leads to a higher chance of complete evacuation but expectant management is successful in at least 76% of women with an incomplete evacuation of the uterus after misoprostol treatment for first trimester miscarriage. WHAT IS KNOWN ALREADY: In 5-50% of the women treated with misoprostol, there is a suspicion of incomplete evacuation of the uterus on sonography. Although these women generally have minor symptoms, such a finding often leads to additional curettage. STUDY DESIGN, SIZE, DURATION: From June 2012 until July 2014, we conducted a nationwide multicenter randomized controlled trial (RCT). Women who had had primary misoprostol treatment for miscarriage with sonographic evidence of incomplete evacuation of the uterus were randomly allocated to either curettage or expectant management (1:1), using a web-based application. PARTICIPANTS/MATERIALS, SETTING, METHODS: We included 59 women in 27 hospitals; 30 were allocated to curettage and 29 were allocated to expectant management. A successful outcome was defined as sonographic finding of an empty uterus 6 weeks after randomization. MAIN RESULTS AND THE ROLE OF CHANCE: Baseline characteristics of both groups were comparable. Empty uterus on sonography or uneventful clinical follow-up was seen in 29/30 women (97%) allocated to curettage compared with 22/29 women (76%) allocated to expectant management (RR 1.3, 95% CI 1.03-1.6) with complication rates of 10% versus 10%, respectively (RR 0.97, 95% CI 0.21-4.4). In the group allocated to curettage, no woman required re-curettage, while two women (6.7%) underwent hysteroscopy (for other or unknown reasons). In the women allocated to expectant management, curettage was performed in four women (13.8%) and three women (10.3%) underwent hysteroscopy. LIMITATIONS, REASONS FOR CAUTION: Du

Published
2016

43. MisoREST: surgical versus expectant management in women with an incomplete evacuation of the uterus after misoprostol treatment for miscarriage: a randomized controlled trial

Author

Epi Methoden Team 1, JC onderzoeksprogramma Methodologie, Lemmers, M, Verschoor, M A C, Oude Rengerink, K, Naaktgeboren, C, Opmeer, B C, Bossuyt, P M, Huirne, J A F, Janssen, C A H, Radder, C, Klinkert, E R, Langenveld, J, Catshoek, R, Van der Voet, L, Siemens, F, Geomini, P, Van Hooff, M H, Van der Ploeg, J M, Coppus, S F P J, Ankum, W M, Mol, B W J, MisoREST study group, Epi Methoden Team 1, JC onderzoeksprogramma Methodologie, Lemmers, M, Verschoor, M A C, Oude Rengerink, K, Naaktgeboren, C, Opmeer, B C, Bossuyt, P M, Huirne, J A F, Janssen, C A H, Radder, C, Klinkert, E R, Langenveld, J, Catshoek, R, Van der Voet, L, Siemens, F, Geomini, P, Van Hooff, M H, Van der Ploeg, J M, Coppus, S F P J, Ankum, W M, Mol, B W J, and MisoREST study group

Published
2016

45. MisoREST: surgical versus expectant management in women with an incomplete evacuation of the uterus after misoprostol treatment for miscarriage: a randomized controlled trial

Author

Lemmers, M., primary, Verschoor, M.A.C., additional, Oude Rengerink, K., additional, Naaktgeboren, C., additional, Opmeer, B.C., additional, Bossuyt, P.M., additional, Huirne, J.A.F., additional, Janssen, C.A.H., additional, Radder, C., additional, Klinkert, E.R., additional, Langenveld, J., additional, Catshoek, R., additional, Van der Voet, L., additional, Siemens, F., additional, Geomini, P., additional, Van Hooff, M.H., additional, Van der Ploeg, J.M., additional, Coppus, S.F.P.J., additional, Ankum, W.M., additional, and Mol, B.W.J., additional

Published
2016
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46. Immediate Delivery Versus Expectant Monitoring for Hypertensive Disorders of Pregnancy Between 34 and 37 Weeks of Gestation (HYPITAT-II): An Open-label, Randomized-Controlled Trial

Author

Broekhuijsen, K., primary, van Baaren, G.J., additional, van Pampus, M.G., additional, Ganzevoort, W., additional, Sikkema, J.M., additional, Woiski, M.D., additional, Oudijk, M.A., additional, Bloemenkamp, K.W., additional, Scheepers, H.C., additional, Bremer, H.A., additional, Rijnders, R.J., additional, van Loon, A.J., additional, Perquin, D.A., additional, Sporken, J.M., additional, Papatsonis, D.N., additional, van Huizen, M.E., additional, Vredevoogd, C.B., additional, Brons, J.T., additional, Kaplan, M., additional, van Kaam, A.H., additional, Groen, H., additional, Porath, M.M., additional, van den Berg, P.P., additional, Mol, B.W., additional, Franssen, M.T., additional, and Langenveld, J., additional

Published
2016
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48. Delivery versus expectant monitoring for late preterm hypertensive disorders of pregnancy (HYPITAT-II): a multicenter, open label, randomized controlled trial

Author

Broekhuijsen, K., Baaren, G.J. van, Pampus, M. van, Sikkema, M., Woiski, M., Oudijk, M., Bloemenkamp, K., Scheepers, H., Bremer, H., Rijnders, R., Loon, A. van, Perquin, D., Sporken, J., Papatsonis, D., Huizen, M. van, Vredevoogd, C., Brons, J., Kaam, A. van, Groen, H., Porath, M., Mol, B., Franssen, M., and Langenveld, J.

Published
2014

49. Prediction of recurrence of hypertensive disorders of pregnancy between 34 and 37 weeks of gestation : A retrospective cohort study

Author

Oostwaard, Miriam, Langenveld, J, Bijloo, R, Wong, KM, Scholten, I, Loix, S, Hukkelhoven, CWPM, Vergouwe, Yvonne, Papatsonis, Dimitri, Mol, BWJ (Ben), Ganzevoort, W, Graduate School, Center for Reproductive Medicine, Obstetrics and Gynaecology, Amsterdam Public Health, Obstetrics & Gynecology, and Public Health

Subjects
HELLP-syndrome, small for gestational age, hypertension, pre-eclampsia, recurrence, Cardiovascular diseases [NCEBP 14], pregnancy
Abstract

Please cite this paper as: van Oostwaard M, Langenveld J, Bijloo R, Wong K, Scholten I, Loix S, Hukkelhoven C, Vergouwe Y, Papatsonis D, Mol B, Ganzevoort W. Prediction of recurrence of hypertensive disorders of pregnancy between 34 and 37 weeks of gestation: a retrospective cohort study. BJOG 2012;119:840847. Objective To assess the recurrence risk of late-preterm hypertensive disease of pregnancy, and to determine whether potential risk factors are predictive. Design Retrospective cohort study. Setting Three secondary and three tertiary care hospitals in the Netherlands. Population We identified women with a hypertensive disorder in the index pregnancy and delivery at 3437 weeks of gestation, between January 2000 and December 2002. Methods Data were extracted from medical files and women were approached for additional information on subsequent pregnancies. An adverse outcome was defined as the recurrence of a hypertensive disorder in the next subsequent pregnancy. Main outcome measures Absolute risk of recurrence and a prediction model containing demographic and clinical factors predictive for adverse outcome. Results We identified 425 women who matched the criteria, of whom 351 could be contacted. Of these women, 189 (54%) had had a subsequent pregnancy. Hypertensive disorders recurred in 96 (51%, 95% CI 4358%) women, of whom 17 (9%, 95% CI 514%) delivered again before 37 weeks of gestation. Chronic hypertension and maternal age were the strongest predictors for recurrence. Women undergoing recurrence had a nine-fold chance of developing chronic hypertension (37% versus 6%, OR 8.7, 95% CI 3.323). Conclusions Women with hypertensive disorders and late-preterm delivery have a 50% chance of recurrence, but only a 9% chance of recurrence resulting in delivery before 37 weeks of gestation. Women with chronic hypertension are prone to develop recurrence, and women with a recurrence more often developed chronic hypertension.

Published
2012

50. Neonatal outcome of pregnancies complicated by hypertensive disorders

Author

Langenveld, J., Ravelli, A.C., van Kaam, A.H., van der Ham, D.P., van Pampus, M.G., Porath, M., Mol, B.W., Ganzevoort, W., and Science in Healthy Ageing & healthcaRE (SHARE)

Abstract

OBJECTIVE: The objective of the study was to determine the neonatal morbidity in late preterm infants born from mothers with a hypertensive disorder. STUDY DESIGN: Data were obtained from the national Perinatal Registry in The Netherlands on women who delivered between 34(+0) and 36(+6) weeks with gestational hypertension (n = 4316), preeclampsia (n = 1864), and normotensive controls (n = 20,749). RESULTS: Children from mothers with preeclampsia had an increased risk for admission to the neonatal intensive care unit compared with children from normotensive mothers (odds ratio [OR], 2.0; 95% confidence interval [CI], 1.8-2.2). A cesarean delivery and decreasing gestational age were independent risk factors for neonatal respiratory morbidity. Gestational hypertension or preeclampsia reduced the risk of respiratory distress syndrome compared with the control group (OR, 0.81; 95% CI, 0.64-1.0 and OR, 0.69; 95% CI, 0.49-0.96, respectively). CONCLUSION: Neonatal morbidity in the late preterm period is considerable. Hypertensive disorders appear to protect for neonatal respiratory morbidity, but higher rates of cesarean section diminish this protective effect.

Published
2011

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