10 research outputs found
Women's attitude towards routine human platelet antigen-screening in pregnancy
Analysis and support of clinical decision makin
Womenâs attitude towards routine human platelet antigen-screening in pregnancy: Attitude towards HPA-screening in pregnancy
Introduction. Fetal and neonatal alloimmune thrombocytopenia is a potentially
life-threatening disease with excellent preventative treatment available for
subsequent pregnancies. To prevent index cases, the effectiveness of a
population-based screening program has been suggested repeatedly. Therefore,
we aimed to evaluate womenâs attitude towards possible future human platelet
antigen-screening in pregnancy. Material and methods. We performed a crosssectional
questionnaire study among healthy pregnant women receiving
prenatal care in one of seven participating midwifery practices. Attitude was
assessed using a questionnaire based on the validated Multidimensional
Measurement of Informed Choice model, containing questions assessing
knowledge, attitude and intention to participate. Results. A total of 143 of the
220 women (65%) completed and returned the questionnaire. A positive
attitude towards human platelet antigen-screening was expressed by 91% of
participants, of which 94% was based on sufficient knowledge. Attitude was
more likely to be negatively influenced by the opinion that screening can be
frightening. Informed choices were made in 87% and occurred significantly less
in women from non-European origin, 89% in European women vs. 60% in
non-European women (p = 0.03). Conclusions. Pregnant women in the
Netherlands expressed a positive attitude towards human platelet antigenscreening
in pregnancy. We therefore expect a high rate of informed uptake
when human platelet antigen-screening is implemented. In future counseling
on human platelet antigen-screening, ethnicity and possible anxiety associated
with a screening test need to be specifically addressed.Research into fetal development and medicin
Women receiving massive transfusion due to postpartum hemorrhage: A comparison over time between two nationwide cohort studies
Introduction Incidence of massive transfusion after birth was high in the Netherlands between 2004 and 2006 compared with other high-income countries. This study investigated incidence, causes, management and outcome of women receiving massive transfusion due to postpartum hemorrhage in the Netherlands in more recent years. Material and methods Data for all pregnant women who received eight or more units of packed red blood cells from a gestational age of 20 weeks and within the first 24 hours after childbirth, during 2011 and 2012, were obtained from a nationwide retrospective cohort study, including 61 hospitals with a maternity unit in the Netherlands. Results Incidence of massive transfusion due to postpartum hemorrhage decreased to 65 per 100 000 births (95% CI 56-75) between 2011 and 2012, from 91 per 100 000 births (95% CI 81-101) between 2004 and 2006, while median blood loss increased from 4500 mL (interquartile range 3250-6000) to 6000 mL (interquartile range 4500-8000). Uterine atony remained the leading cause of hemorrhage. Thirty percent (53/176) underwent peripartum hysterectomy between 2011 and 2012, compared with 25% (83/327) between 2004 and 2006. Case fatality rate for women who received massive transfusion due to postpartum hemorrhage was 2.3% (4/176) between 2011 and 2012, compared with 0.9% (3/327) between 2004 and 2006. Conclusions The incidence of postpartum hemorrhage with massive transfusion decreased in the Netherlands between both time frames, but remained an important cause of maternal mortality and morbidity, including peripartum hysterectomy. National surveillance of maternal morbidity and mortality due to postpartum hemorrhage through an improved and continuous registration with confidential enquiries may lead to the identification of clear improvements of maternal care
Comparison of outcome between intrauterine balloon tamponade and uterine artery embolization in the management of persistent postpartum hemorrhage: A propensity score-matched cohort study
Research into fetal development and medicin
The Transpolar Drift as a Source of Riverine and ShelfâDerived Trace Elements to the Central Arctic Ocean
A major surface circulation feature of the Arctic Ocean is the Transpolar Drift (TPD), a current that transports riverâinfluenced shelf water from the Laptev and East Siberian Seas toward the center of the basin and Fram Strait. In 2015, the international GEOTRACES program included a highâresolution panâArctic survey of carbon, nutrients, and a suite of trace elements and isotopes (TEIs). The cruises bisected the TPD at two locations in the central basin, which were defined by maxima in meteoric water and dissolved organic carbon concentrations that spanned 600 km horizontally and ~25â50 m vertically. Dissolved TEIs such as Fe, Co, Ni, Cu, Hg, Nd, and Th, which are generally particleâreactive but can be complexed by organic matter, were observed at concentrations much higher than expected for the openocean setting. Other trace element concentrations such as Al, V, Ga, and Pb were lower than expected due to scavenging over the productive East Siberian and Laptev shelf seas. Using a combination of radionuclide tracers and ice drift modeling, the transport rate for the core of the TPD was estimated at 0.9 ± 0.4 Sv(106m3 sâ1). This rate was used to derive the mass flux for TEIs that were enriched in the TPD, revealing the importance of lateral transport in supplying materials beneath the ice to the central Arctic Ocean and potentially to the North Atlantic Ocean via Fram Strait. Continued intensification of the Arctic hydrologicc ycle and permafrost degradation will likely lead to an increase in the flux of TEIs into the Arctic Ocean