Induction versus expectant monitoring for intrauterine growth restriction at term: randomised equivalence trial (DIGITAT)

Objective To compare the effect of induction of labour with a policy of expectant monitoring for intrauterine growth restriction near term

Induction versus expectant monitoring for intrauterine growth restriction at term: Randomised equivalence trial (DIGITAT)

Objective: To compare the effect of induction of labour with a policy of expectant monitoring for intrauterine growth restriction near term. Design: Multicentre randomised equivalence trial (the Disproportionate Intrauterine Growth Intervention Trial At Term (DIGITAT)). Setting: Eight academic and 44 non-academic hospitals in the Netherlands between November 2004 and November 2008. Participants: Pregnant women who had a singleton pregnancy beyond 36+0 weeks' g

Development and measurement of guidelines-based quality indicators of caesarean section care in the Netherlands: A RAND-modified delphi procedure and retrospective medical chart review

Background There is an ongoing discussion on the rising CS rate worldwide. Suboptimal guideline adherence may be an important contributor to this rise. Before improvement of care can be established, optimal CS care in different settings has to be defined. This study aimed to develop and measure quality indicators to determine guideline adherence and identify target groups for improvement of care with direct effect on caesarean section (CS) rates. Method Eighteen obstetricians and midwives participated in an expert panel for systematic CS quality indicator development according to the RAND-modified Delphi method. A multi-center study was performed and medical charts of 1024 women with a CS and a stratified and weighted randomly selected group of 1036 women with a vaginal delivery were analysed. Quality indicator frequency and adherence were scored in 2060 women with a CS or vaginal delivery. Results The expert panel developed 16 indicators on planned CS and 11 indicators on unplanned CS. Indicator adherence was calculated, defined as the number of women in a specific obstetrical situation in which care was performed as recommended in both planned and unplanned CS settings. The most frequently occurring obstetrical situations with low indicator adherence were: 1) suspected fetal distress (frequency 17%, adh

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

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 haemo

Effects of fetal activity on umbilical venous blood flow in the fetal lamb.

Peer Reviewe

Cardiotocografie

Item does not contain fulltex

Anaphylaxis after iron dextran administration in a pregnant woman

Item does not contain fulltex

[Shock in pregnancy: foetal distress may be the first symptom]

Item does not contain fulltextShock may be difficult to recognize in pregnant women due to the physiological changes that take place in the cardiovascular system. The first symptom of shock may be foetal distress. We present two patients to illustrate this condition. The first patient had an uncomplicated pregnancy until she awoke from a 'pop' in her abdomen followed by an acute feeling of illness. She was hemodynamically stable but because the foetal heart rate pattern was abnormal, an emergency caesarean section was performed. This revealed an intraperitoneal bleeding of the uterine artery in the right broad ligament, caused by ectopic decidualization. The second patient had severe symptomatic renal dilatation in pregnancy which was managed through percutaneous nephrostomy. Following the procedure she became hypotensive, tachycardic and hyperthermic, indications of septic shock. A neonate with signs of asphyxia was born by emergency caesarean section undertaken for acute foetal distress evident from the foetal heart rate pattern

Transient umbilical cord occlusion in late-gestation fetal sheep results in hippocampal damage but not in cerebral arteriovenous difference for nitrite, a stable end product of nitric oxide.

Department of Obstetrics and Gynecology, University Hospital Maastricht, The Netherlands. OBJECTIVE: To investigate the effect of total umbilical cord occlusion on cerebral arteriovenous difference for nitrite (a stable end product of nitric oxide) and neuronal outcome. METHOD: The cord was totally occluded for 10 minutes in 14 late-gestation (gestational age 113-120 days) chronically instrumented fetal sheep. Arterial (carotid artery) and venous (superior sagittal sinus) blood samples were taken at regular intervals for determination of acid-base status, glucose, lactate, and nitrite plasma levels. Three days after the occlusion period the fetal brain was perfusion fixed, and the parietal cortex, hippocampus, and cerebellum were scored for neuronal damage. RESULTS: Three fetuses died shortly after the occlusion period. Total umbilical cord occlusion resulted in a combined respiratory and metabolic acidosis as observed in carotid arterial blood gas samples (pH, 6.96 +/- 0.02; CaO2 [mmol/L], 0.43 +/- 0.9; PaCO2 [kPa], 13.46 +/- 0.38; base excess [mmol/L], -11.1 +/- 0.8; lactate [mmol/L], 10.57 +/- 0.95; bradycardia, 75 +/- 9 bpm; and hypotension, 29.85 +/- 3.00 mmHg) (n = 14, values are mean +/- standard error of the mean). Selective brain damage was observed in the hippocampus in 10 of the 11 surviving fetal sheep. No changes in arterial, venous, or cerebral arteriovenous difference for nitrite plasma levels were observed (n = 11). CONCLUSION: Total umbilical cord occlusion of 10 minutes in preterm fetal sheep results in hippocampal damage but not in changes of cerebral arteriovenous difference for nitrite plasma levels, a stable end product of nitric oxide