The reliability of perinatal and neonatal mortality rates: Differential under-reporting in linked professional registers vs. Dutch civil registers

Official Dutch perinatal mortality rates are based on birth and death certificates. These civil registration data are not detailed enough for international comparisons or extensive epidemiological research. In this study, we linked and extrapolated three national incomplete, professional registers from midwives, obstetricians and paediatricians, containing detailed perinatal information. This linkage and extrapolation resulted in one detailed professional database which is representative of all Dutch births and from which gestational age-specific perinatal mortality rates could be calculated. The reliability of these calculated mortality rates was established by comparing them with the rates derived from the national civil registers. The professional database reported more perinatal deaths and fewer late neonatal deaths than the civil registers. The underreporting in the civil registers amounted to 1.2 fewer perinatal deaths per 1000 births and was most apparent in immature newborns. We concluded that under-reporting of perinatal and neonatal deaths depends on the data source used. Mortality rates for the purpose of national and international comparison should, therefore, be defined with caution. This study also demonstrated that combining different incomplete professional registers can result in a more reliable database containing detailed perinatal information. Such databases can be used as the basis for extensive perinatal epidemiological research

Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Toegenomen bloedverlies in verticale baringshouding veroorzaakt perineumletsel

Contains fulltext : 55999.pdf (publisher's version ) (Open Access

Aangeboren afwijkingen in Nederland 2001-2012 : Gebaseerd op de landelijke perinatale registraties

Het jaarlijkse monitoren van aangeboren afwijkingen is van belang om eventuele (plotselinge) dalingen of stijgingen in aantallen (trends) tijdig te signaleren. In de periode 2010-2012 hebben wij geen zorgwekkende stijging in het voorkomen van specifieke aangeboren afwijkingen kunnen constateren. Op orgaanstelniveau tonen drie van de acht orgaanstelsels stijgende trends, namelijk het orgaanstelsel hart en bloedvaten (p=0,029), het urogenitaalstelsel (p=0,001) en voor chromosomale, syndromale en diverse afwijkingen (p<0,001). Voor de overige vijf orgaanstelsels - het centraal zenuwstelsel en zintuigen (p=0,198), het ademhalingsstelsel (p=0,150), het spijsverteringsstelsel (p=0,473), het orgaanstelsel huid en buikwand (p=0,340) en het skelet en spierstelsel (p=0,919) zijn geen significante trends waargenomen

Change in male: female ratio among newborn babies in Netherlands

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Durante partu naar het geboortecentrum: een secundaire analyse van het geboortecentrumonderzoek.

Ruim 30% van de vrouwen die in een geboortecentrum willen bevallen, komt daar uiteindelijk niet terecht. Dat concludeert Marieke Hermus in haar onderzoek. De vrouwen die er wel komen worden minder snel verwezen naar de tweede lijn wanneer zij eerst thuis getoucheerd worden. (aut. ref.