6 results on '"Leemhuis, Aleid G."'
Search Results
2. Temporizing management vs immediate delivery in early-onset severe preeclampsia between 28 and 34 weeks of gestation (TOTEM study): An open-label randomized controlled trial.
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Duvekot, Johannes J., Duijnhoven, Ruben G., Horen, Eva, Bax, Caroline J., Bloemenkamp, Kitty W., Brussé, Ingrid A., Dijk, Peter H., Franssen, Maureen T., Franx, Arie, Oudijk, Martijn A., Porath, Martina M., Scheepers, Hubertina C., Wassenaer‐Leemhuis, Aleid G., Drongelen, Joris, Mol, Ben W., Ganzevoort, Wessel, van Horen, Eva, van Wassenaer-Leemhuis, Aleid G, van Drongelen, Joris, and TOTEM study collaboration group
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ABRUPTIO placentae ,RANDOMIZED controlled trials ,PREECLAMPSIA ,INDUCED labor (Obstetrics) ,PREGNANCY ,NEONATAL death ,CESAREAN section ,RESEARCH ,RESEARCH methodology ,GESTATIONAL age ,EVALUATION research ,MEDICAL cooperation ,PREGNANCY outcomes ,COMPARATIVE studies ,DELIVERY (Obstetrics) - Abstract
Introduction: There is little evidence to guide the timing of delivery of women with early-onset severe preeclampsia. We hypothesize that immediate delivery is not inferior for neonatal outcome but reduces maternal complications compared with temporizing management.Material and Methods: This Dutch multicenter open-label randomized clinical trial investigated non-inferiority for neonatal outcome of temporizing management as compared with immediate delivery (TOTEM NTR 2986) in women between 27+5 and 33+5 weeks of gestation admitted for early-onset severe preeclampsia with or without HELLP syndrome. In participants allocated to receive immediate delivery, either induction of labor or cesarean section was initiated at least 48 hours after admission. Primary outcomes were adverse perinatal outcome, defined as a composite of severe respiratory distress syndrome, bronchopulmonary dysplasia, culture proven sepsis, intraventricular hemorrhage grade 3 or worse, periventricular leukomalacia grade 2 or worse, necrotizing enterocolitis stage 2 or worse, and perinatal death. Major maternal complications were secondary outcomes. It was estimated 1130 women needed to be enrolled. Analysis was by intention-to-treat.Results: The trial was halted after 35 months because of slow recruitment. Between February 2011 and December 2013, a total of 56 women were randomized to immediate delivery (n = 26) or temporizing management (n = 30). Median gestational age at randomization was 30 weeks. Median prolongation of pregnancy was 2 days (interquartile range 1-3 days) in the temporizing management group. Mean birthweight was 1435 g after immediate delivery vs 1294 g after temporizing management (P = .14). The adverse perinatal outcome rate was 55% in the immediate delivery group vs 52% in the temporizing management group (relative risk 1.06; 95% confidence interval 0.67-1.70). In both groups there was one neonatal death and no maternal deaths. In the temporizing treatment group, one woman experienced pulmonary edema and one placental abruption. Analyses of only the singleton pregnancies did not result in other outcomes.Conclusions: Early termination of the trial precluded any conclusions for the main outcomes. We observed that temporizing management resulted in a modest prolongation of pregnancy without changes in perinatal and maternal outcome. Conducting a randomized study for this important research question did not prove feasible. [ABSTRACT FROM AUTHOR]- Published
- 2021
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3. Early-onset fetal growth restriction: A systematic review on mortality and morbidity.
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Pels, Anouk, Beune, Irene M., van Wassenaer‐Leemhuis, Aleid G., Limpens, Jacqueline, Ganzevoort, Wessel, and van Wassenaer-Leemhuis, Aleid G
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FETAL development ,META-analysis ,NEONATAL mortality ,RESPIRATORY distress syndrome ,PERINATAL death ,NEONATAL diseases ,SYSTEMATIC reviews ,FETAL growth retardation ,PROGNOSIS ,GESTATIONAL age ,INFANT mortality - Abstract
Introduction: Severe early-onset fetal growth restriction is an obstetric condition with significant risks of perinatal mortality, major and minor neonatal morbidity, and long-term health sequelae. The prognosis of a fetus is influenced by the extent of prematurity and fetal weight. Clinical care is individually adjusted. In literature, survival rates vary and studies often only include live-born neonates with missing rates of antenatal death. This systematic review aims to summarize the literature on mortality and morbidity.Material and Methods: A broad literature search was conducted in OVID MEDLINE from 2000 to 26 April 2019 to identify studies on fetal growth restriction and perinatal death. Studies were excluded when all included children were born before 2000 because (neonatal) health care has considerably improved since this period. Studies were included that described fetal growth restriction diagnosed before 32 weeks of gestation and antenatal mortality and neonatal mortality and/or morbidity as outcome. Quality of evidence was rated with the GRADE instrument.Results: Of the 2604 publications identified, 25 studies, reporting 2895 pregnancies, were included in the systematic review. Overall risk of bias in most studies was judged as low. The quality of evidence was generally rated as very low to moderate, except for 3 large well-designed randomized controlled trials. When combining all data on mortality, in 355 of 2895 pregnancies (12%) the fetus died antenatally, 192 died in the neonatal period (8% of live-born neonates) and 2347 (81% of all pregnancies) children survived. Of the neonatal morbidities recorded, respiratory distress syndrome (34% of the live-born neonates), retinopathy of prematurity (13%) and sepsis (30%) were most common. Of 476 children that underwent neurodevelopmental assessment, 58 (12% of surviving children, 9% of all pregnancies) suffered from cognitive impairment and/or cerebral palsy.Conclusions: When combining the data of 25 included studies, survival in fetal growth restriction pregnancies, diagnosed before 32 weeks of gestation, was 81%. Neurodevelopmental impairment was assessed in a minority of surviving children. Individual prognostic counseling on the basis of these results is hampered by differences in patient and pregnancy characteristics within the included patient groups. [ABSTRACT FROM AUTHOR]- Published
- 2020
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4. Early‐onset fetal growth restriction: A systematic review on mortality and morbidity
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Pels, Anouk, primary, Beune, Irene M., additional, van Wassenaer‐Leemhuis, Aleid G., additional, Limpens, Jacqueline, additional, and Ganzevoort, Wessel, additional
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- 2019
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5. Child outcomes after placement of a cervical pessary in women with a multiple pregnancy: A 4‐year follow‐up of the ProTWIN trial
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Simons, Noor E., primary, Beek, Cornelieke, additional, Lee, Johanna H., additional, Opmeer, Brent C., additional, Wassenaer‐Leemhuis, Aleid G., additional, Baar, Anneloes L., additional, Steenis, Leonie, additional, Liem, Sophie, additional, Schuit, Ewoud, additional, Bekedam, Dick, additional, Mol, Ben W. J., additional, and Hooft, Janneke, additional
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- 2019
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6. The capacity of mid-pregnancy cervical length to predict preterm birth in low-risk women: a national cohort study.
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Ven, Jeanine, Os, Melanie A., Kazemier, Brenda M., Kleinrouweler, Emily, Verhoeven, Corine J., Miranda, Esteriek, Wassenaer‐Leemhuis, Aleid G., Kuiper, Petra N., Porath, Martina, Willekes, Christine, Woiski, Mallory D., Sikkema, Marko J., Roumen, Frans J.M.E., Bossuyt, Patrick M., Haak, Monique C., Groot, Christianne J.M., Mol, Ben W.J., and Pajkrt, Eva
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ANTHROPOMETRY ,CERVIX uteri ,FETAL ultrasonic imaging ,PREMATURE infants ,LONGITUDINAL method ,SECOND trimester of pregnancy ,PROBABILITY theory ,PROGNOSIS ,PARITY (Obstetrics) ,RECEIVER operating characteristic curves - Abstract
Introduction: We investigated the predictive capacity of mid-trimester cervical length (CL) measurement for spontaneous and iatrogenic preterm birth.Material and Methods: We performed a prospective observational cohort study in nulliparous women and low-risk multiparous women with a singleton pregnancy between 16(+0) and 21(+6) weeks of gestation. We assessed the prognostic capacity of transvaginally measured mid-trimester CL for spontaneous and iatrogenic preterm birth (<37 weeks) using likelihood ratios (LR) and receiver-operating-characteristic analysis. We calculated numbers needed to screen to prevent one preterm birth assuming different treatment effects. Main outcome measures were preterm birth <32, <34 and <37 weeks.Results: We studied 11,943 women, of whom 666 (5.6%) delivered preterm: 464 (3.9%) spontaneous and 202 (1.7%) iatrogenic. Mean CL was 44.1 mm (SD 7.8 mm). In nulliparous women, the LRs for spontaneous preterm birth varied between 27 (95% CI 7.7-95) for a CL ≤ 20 mm, and 2.0 (95% CI 1.6-2.5) for a CL between 30 and 35 mm. For low-risk multiparous women, these LRs were 37 (95% CI 7.5-182) and 1.5 (95% CI 0.97-2.2), respectively. Using a cut-off for CL ≤ 30 mm, 28 (6.0%) of 464 women with spontaneous preterm birth were identified. The number needed to screen to prevent one case of preterm birth was 618 in nulliparous women and 1417 for low-risk multiparous women (40% treatment effect, cut-off 30 mm).Conclusion: In women at low risk of preterm birth, CL predicts spontaneous preterm birth. However, its isolated use as a screening tool has limited value due to low sensitivity. [ABSTRACT FROM AUTHOR]- Published
- 2015
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