69 results on '"Bekedam, DJ"'
Search Results
2. Maternal temperature during labour
- Author
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Schouten, FD, Wolf, H, Smit, BJ, Bekedam, DJ, de Vos, R, and Wahlen, I
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- 2008
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3. Spontaneous liver haemorrhage during pregnancy: a rare and life-threatening situation
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Boormans, EMA, Bekedam, DJ, Lenters, E, Schoonderbeek, FJ (Fenna), Tilanus, Hugo, Intensive Care, and Surgery
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- 2007
4. Heart rate variation and movement incidence in growth-retarded fetuses with decelerative heart rate patterns: correlations with fetal acid-base status
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Bekedam, DJ, primary and Visser, GHA, additional
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- 1986
- Full Text
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5. Pessaries in multiple pregnancy as a prevention of preterm birth: the ProTwin Trial (vol 9, 44, 2009)
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Liem, SMS, Bekedam, DJ, Bloemenkamp, KWM, Kwee, A, Papatsonis, Dimitri, van der Post, JAM, Lim, AC, Scheepers, HCJ, Willekes, C, Duvekot, J.J., Spaanderman, M, Porath, M, van Eyck, J, Haak, MC, van Pampus, MG, Bruinse, HW, Mol, BWJ (Ben), Hegeman, MA, Liem, SMS, Bekedam, DJ, Bloemenkamp, KWM, Kwee, A, Papatsonis, Dimitri, van der Post, JAM, Lim, AC, Scheepers, HCJ, Willekes, C, Duvekot, J.J., Spaanderman, M, Porath, M, van Eyck, J, Haak, MC, van Pampus, MG, Bruinse, HW, Mol, BWJ (Ben), and Hegeman, MA
- Published
- 2012
6. Pessaries in multiple pregnancy as a prevention of preterm birth: the ProTwin Trial
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Hegeman, MA, Bekedam, DJ, Bloemenkamp, KWM, Kwee, A, Papatsonis, Dimitri, Van der Post, JAM, Lim, AC, Scheepers, HCJ, Willekes, C, Duvekot, J.J., Spaanderman, M, Porath, MM, van Eyck, J, Haak, MC, van Pampus, MG, Bruinse, HW, Mol, BWJ (Ben), Hegeman, MA, Bekedam, DJ, Bloemenkamp, KWM, Kwee, A, Papatsonis, Dimitri, Van der Post, JAM, Lim, AC, Scheepers, HCJ, Willekes, C, Duvekot, J.J., Spaanderman, M, Porath, MM, van Eyck, J, Haak, MC, van Pampus, MG, Bruinse, HW, and Mol, BWJ (Ben)
- Published
- 2009
7. Disproportionate intrauterine growth intervention trial at term: DIGITAT
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Boers, KE, Bijlenga, D, Mol, BWJ (Ben), le Cessie, S, Birnie, Erwin, van Pampus, MG, Stigter, RH, Bloemenkamp, KWM, van Meir, CA, Van der Post, JAM, Bekedam, DJ, Ribbert, LSM, Drogtrop, AP, van der Salm, PCM, Huisjes, AJM, Willekes, C, Roumen, FJME, Scheepers, HCJ, de Boer, K, Duvekot, JJ, Thornton, JG, Scherjon, SA, Boers, KE, Bijlenga, D, Mol, BWJ (Ben), le Cessie, S, Birnie, Erwin, van Pampus, MG, Stigter, RH, Bloemenkamp, KWM, van Meir, CA, Van der Post, JAM, Bekedam, DJ, Ribbert, LSM, Drogtrop, AP, van der Salm, PCM, Huisjes, AJM, Willekes, C, Roumen, FJME, Scheepers, HCJ, de Boer, K, Duvekot, JJ, Thornton, JG, and Scherjon, SA
- Published
- 2007
8. PRENATAL-DIAGNOSIS IN 2 CASES OF DE-NOVO COMPLEX BALANCED CHROMOSOMAL REARRANGEMENTS - 3-YEAR FOLLOW-UP IN ONE CASE
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SIKKEMARADDATZ, B, SIJMONS, RH, TANSINDHUNATA, MB, VANDERVEEN, AY, BRUNSTING, R, DEVRIES, B, BEEKHUIS, [No Value], BEKEDAM, DJ, VANAKEN, B, DEJONG, B, and Guided Treatment in Optimal Selected Cancer Patients (GUTS)
- Subjects
PRENATAL DIAGNOSIS ,FISH ,COUNSELING ,DE NOVO COMPLEX BALANCED REARRANGEMENTS ,FOLLOW-UP ,HYBRIDIZATION - Abstract
We report two cases of apparently balanced complex de novo chromosomal rearrangements (BCCR) detected prenatally at 17 weeks and 10 weeks of gestation, respectively. Chromosomes were studied using GTG-banding and fluorescent in situ hybridization (FISH). In one case four chromosomes and in the other case three chromosomes were involved in the rearrangements. One of the pregnancies was terminated and no external or internal abnormalities were detected at autopsy. The other pregnancy continued to term. Level III ultrasound examination showed no abnormalities. The child is now 3 years old and has neither congenital anomalies nor evidence of delayed psychomotor development.
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- 1995
9. THE EFFECTS OF MATERNAL HYPEROXIA ON FETAL BREATHING MOVEMENTS, BODY MOVEMENTS AND HEART-RATE VARIATION IN GROWTH RETARDED FETUSES
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BEKEDAM, DJ, MULDER, EJH, SNIJDERS, RJM, and VISSER, GHA
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MATERNAL HYPEROXYGENATION ,SECTION ,BLOOD-FLOW ,embryonic structures ,PATTERNS ,INTRAUTERINE GROWTH RETARDATION ,FETAL HYPOXEMIA ,RETARDATION ,reproductive and urinary physiology ,FETAL MOVEMENTS, FETAL HEART RATE VARIATION - Abstract
In hypoxemic intrauterine growth-retarded fetuses (IUGR) there is a reduction in the incidence of fetal movements and in fetal heart rate variation. A causal relationship with the impairment of fetal oxygenation has been suggested. In 16 IUGR fetuses and in 13 normally grown fetuses maternal hyperoxygenation was applied for 40 min to increase fetal PO2 levels. All IUGR fetuses had abnormal Doppler blood velocity waveforms of the umbilical artery suggesting an impaired uteroplacental exchange. The effect of hyperoxygenation on fetal breathing and body movements and on fetal heart rate was evaluated. In the IUGR fetuses there was a significant increase in fetal breathing and body movements and in heart rate variation during hyperoxygenation as compared to the preceding control period of 40 min. No significant changes in fetal breathing and body movements were found in the normally grown control fetuses. A surprising observation was the increase of the number of heart rate decelerations after discontinuation of the maternal hyperoxygenation. It is concluded that in IUGR fetuses the increase in fetal heart rate variation and the increase in the incidence of breathing and body movements during maternal hyperoxygenation substantiates the relationship between these variables and the oxygenation status of the fetus.
- Published
- 1991
10. ABNORMAL VELOCITY WAVE-FORMS OF THE UMBILICAL ARTERY IN GROWTH RETARDED FETUSES - RELATIONSHIP TO ANTEPARTUM LATE HEART-RATE DECELERATIONS AND OUTCOME
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BEKEDAM, DJ, VISSER, GHA, VANDERZEE, AGJ, SNIJDERS, RJM, POELMANNWEESJES, G, and Targeted Gynaecologic Oncology (TARGON)
- Published
- 1990
11. Changes in antepartum heart-rate patterns with progressive deterioration of the fetal condition
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VISSER, GHA, BEKEDAM, DJ, and RIBBERT, LSM
- Published
- 1990
12. An economic analysis of induction of labour and expectant monitoring in women with gestational hypertension or pre-eclampsia at term (HYPITAT trial)
- Author
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Vijgen SM, Koopmans CM, Opmeer BC, Groen H, Bijlenga D, Aarnoudse JG, Bekedam DJ, van den Berg PP, de Boer K, Burggraaff JM, Bloemenkamp KW, Drogtrop AP, Franx A, de Groot CJ, Huisjes AJ, Kwee A, van Loon AJ, Lub A, Papatsonis DN, and van der Post JA
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- 2010
- Full Text
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13. DELAYED EMERGENCE OF FETAL BEHAVIOR IN TYPE-1 DIABETIC WOMEN
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VISSER, GHA, BEKEDAM, DJ, MULDER, EJH, VANBALLEGOOIE, E, and Faculteit Medische Wetenschappen/UMCG
- Published
- 1985
14. THE EFFECT OF (INDUCED) MATERNAL EMOTIONS ON FETAL BEHAVIOR - A CONTROLLED-STUDY
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VANDENBERGH, BRH, MULDER, EJH, VISSER, GHA, POELMANNWEESJES, G, BEKEDAM, DJ, and PRECHTL, HFR
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- 1989
15. FETAL BEHAVIOR IN TYPE-1 DIABETIC WOMEN
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VISSER, GHA, MULDER, EJH, BEKEDAM, DJ, VANBALLEGOOIE, E, PRECHTL, HFR, and Faculteit Medische Wetenschappen/UMCG
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- 1986
16. MOTOR BEHAVIOR IN THE GROWTH RETARDED FETUS
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BEKEDAM, DJ, VISSER, GHA, and PRECHTL, HFR
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- 1985
17. ABNORMAL MOTOR BEHAVIOR IN ANENCEPHALIC FETUSES
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VISSER, GHA, LAURINI, RN, DEVRIES, JIP, BEKEDAM, DJ, and PRECHTL, HFR
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- 1985
18. The effect of (induced) maternal emotions on fetal behaviour: A controlled study
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Van den Bergh, BRH, primary, Mulder, EJH, additional, Visser, GHA, additional, Poelmann-Weesjes, G, additional, Bekedam, DJ, additional, and Prechtl, HFR, additional
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- 1989
- Full Text
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19. The Metformin Paradox.
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Weijers RNM and Bekedam DJ
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- Blood Glucose metabolism, Cell Membrane metabolism, Diabetes Mellitus, Type 2 blood, Diabetes Mellitus, Type 2 drug therapy, Diabetes Mellitus, Type 2 therapy, Disease Progression, Erythrocyte Membrane drug effects, Erythrocyte Membrane metabolism, Healthy Lifestyle, Humans, Hypoglycemic Agents pharmacology, Hypoglycemic Agents therapeutic use, Metformin pharmacology, Metformin therapeutic use, Prediabetic State blood, Prediabetic State drug therapy, Prediabetic State therapy, Risk Assessment, Risk Factors, Cell Membrane drug effects, Diabetes Mellitus, Type 2 metabolism, Fatty Acids metabolism, Hypoglycemic Agents adverse effects, Metformin adverse effects, Prediabetic State metabolism
- Abstract
Introduction: The Diabetes Prevention Program study results indicated that metformin therapy was not as beneficial as a lifestyle modification for delaying the development of type 2 diabetes in individuals at high risk of the disease. A key feature in the etiology of type 2 diabetes mellitus, which appears in the prediabetic phase, is a significant deficiency, compared to healthy controls, in highly flexible poly-cis-unsaturated fatty acyl chains in membrane phospholipids. This deficiency lowers membrane flexibility, which in turn, reduces the amount of all functional Class I glucose transporters, and thereby reduces glucose-mediated ATP production. This leads to an increase in essentially saturated free fatty acid (FFA) levels for fatty-acid-mediated ATP production, which will set up a vicious cycle of raising the levels of essentially saturated FFAs and lowering the level of transmembrane glucose transport. Metformin suppresses hepatic gluconeogenesis, which reduces the plasma glucose concentration., Conclusion: We hypothesize that chronic metformin treatment leads to an additional increase in essentially saturated FFAs, which causes an additional rise in membrane stiffness and hypoxia. So we propose that all these metformin-mediated activities accelerated the onset of type 2 diabetes in the participants of the metformin group in the Diabetes Prevention Program study, compared to the participants of the lifestyle-intervention group in this study. We propose that the biochemical reactions, involved in the fatty-acid-mediated ATP production, play an important part in the increase of the observed essentially saturated FFA concentrations. These statements should also extend to the metformin therapy of individuals with type 2 diabetes., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)
- Published
- 2020
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20. Continuous glucose monitoring during diabetic pregnancy (GlucoMOMS): A multicentre randomized controlled trial.
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Voormolen DN, DeVries JH, Sanson RME, Heringa MP, de Valk HW, Kok M, van Loon AJ, Hoogenberg K, Bekedam DJ, Brouwer TCB, Porath M, Erdtsieck RJ, NijBijvank B, Kip H, van der Heijden OWH, Elving LD, Hermsen BB, Potter van Loon BJ, Rijnders RJP, Jansen HJ, Langenveld J, Akerboom BMC, Kiewiet RM, Naaktgeboren CA, Mol BWJ, Franx A, and Evers IM
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- Adult, Combined Modality Therapy, Diabetes Mellitus, Type 1 physiopathology, Diabetes Mellitus, Type 1 therapy, Diabetes Mellitus, Type 2 physiopathology, Diabetes Mellitus, Type 2 therapy, Diabetes, Gestational physiopathology, Diabetes, Gestational therapy, Female, Fetal Macrosomia epidemiology, Fetal Macrosomia etiology, Glycated Hemoglobin analysis, Humans, Hyperglycemia prevention & control, Hypoglycemia prevention & control, Incidence, Infant, Newborn, Intention to Treat Analysis, Lost to Follow-Up, Male, Netherlands epidemiology, Patient Dropouts, Pregnancy, Pregnancy in Diabetics physiopathology, Pregnancy in Diabetics therapy, Risk, Blood Glucose analysis, Diabetes Mellitus, Type 1 blood, Diabetes Mellitus, Type 2 blood, Diabetes, Gestational blood, Fetal Macrosomia prevention & control, Monitoring, Ambulatory, Pregnancy in Diabetics blood
- Abstract
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., (© 2018 John Wiley & Sons Ltd.)
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- 2018
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21. Pessary for prevention of preterm birth in twin pregnancy with short cervix: 3-year follow-up study.
- Author
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van 't Hooft J, van der Lee JH, Opmeer BC, van Wassenaer-Leemhuis AG, van Baar AL, Bekedam DJ, Steenis LJP, Liem S, Schuit E, Cuijpers C, Bleeker E, Vinke ME, Simons N, de Graaf IM, Mol BWJ, and van de Beek C
- Subjects
- Adult, Cervical Length Measurement statistics & numerical data, Cervix Uteri diagnostic imaging, Child, Preschool, Female, Follow-Up Studies, Gestational Age, Humans, Infant, Newborn, Male, Neurodevelopmental Disorders diagnosis, Neurodevelopmental Disorders etiology, Pregnancy, Pregnancy Outcome epidemiology, Premature Birth epidemiology, Statistics, Nonparametric, Neurodevelopmental Disorders epidemiology, Pessaries, Pregnancy, Twin, Premature Birth prevention & control
- Abstract
Objective: A recent randomized clinical trial (ProTWIN) showed that a cervical pessary prevented preterm birth and improved neonatal outcome in women with multiple pregnancy and cervical length (CL) < 38 mm. In this follow-up study, the long-term developmental outcome of these children was evaluated at 3 years' corrected age., Methods: This was a follow-up study of ProTWIN, a multicenter trial conducted between 2009 and 2012 in which asymptomatic women with a multiple pregnancy were randomized to placement of a cervical pessary or no intervention. Current follow-up and analysis were limited to mothers with a mid-trimester CL < 38 mm (78 women (157 children) in the pessary group and 55 women (111 children) in the control group). At 3 years of corrected age, surviving children were invited for a Bayley Scales of Infant and Toddler Development-third edition (Bayley-III) assessment. Death after randomization or neurodevelopmental disability (Bayley-III score of ≤ 85, 1 SD below mean) rates were compared between the pessary and control groups, according to the intention-to-treat principle and using multiple imputation for missing data. Mean Bayley-III scores in surviving children were also assessed. A linear mixed-effects model was used to adjust for correlation between children of one mother., Results: From the time of entry in the ProTWIN trial until follow-up at 3 years of age, a total of 27 children had died (six (5%) in the pessary vs 21 (26%) in the control group; odds ratio (OR), 0.13; 95% CI, 0.04-0.48). Bayley-III outcomes were collected for 173/241 (72%) surviving children (114 (75%) in the pessary vs 59 (66%) in the control group). The cumulative incidence of death or survival with a neurodevelopmental disability was 12 (10%) in the pessary vs 23 (29%) in the control group (OR, 0.26; 95% CI, 0.09-0.73). No statistical or clinically relevant differences were found with respect to cognitive, language and motor development among surviving children between the groups. Comparable results were found after multiple imputation., Conclusion: In women with twin pregnancy and a CL < 38 mm, the use of a cervical pessary strongly improved survival of the children without affecting neurodevelopment at 3 years' corrected age. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd., (Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.)
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- 2018
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22. Pessary or Progesterone to Prevent Preterm delivery in women with short cervical length: the Quadruple P randomised controlled trial.
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van Zijl MD, Koullali B, Naaktgeboren CA, Schuit E, Bekedam DJ, Moll E, Oudijk MA, van Baal WM, de Boer MA, Visser H, van Drongelen J, van de Made FW, Vollebregt KC, Muller MA, Bekker MN, Brons JTJ, Sueters M, Langenveld J, Franssen MT, Schuitemaker NW, van Beek E, Scheepers HCJ, de Boer K, Tepe EM, Huisjes AJM, Hooker AB, Verheijen ECJ, Papatsonis DN, Mol BWJ, Kazemier BM, and Pajkrt E
- Subjects
- Administration, Intravaginal, Adolescent, Adult, Cervical Length Measurement, Clinical Protocols, Female, Humans, Pregnancy, Pregnancy Outcome, Premature Birth etiology, Treatment Outcome, Uterine Cervical Diseases diagnostic imaging, Uterine Cervical Diseases pathology, Young Adult, Cervix Uteri pathology, Pessaries, Premature Birth prevention & control, Progesterone administration & dosage, Progestins administration & dosage, Uterine Cervical Diseases complications
- Abstract
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 intensive care unit, maternal morbidity, maternal admission days for threatened preterm labour and costs., Discussion: This trial will provide evidence on whether vaginal progesterone or a cervical pessary is more effective in decreasing adverse perinatal outcome in both singletons and multiples., Trial Registration: Trial registration number: NTR 4414 . Date of registration January 29th 2014.
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- 2017
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23. A multi-centre, non-inferiority, randomised controlled trial to compare a cervical pessary with a cervical cerclage in the prevention of preterm delivery in women with short cervical length and a history of preterm birth - PC study.
- Author
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Koullali B, van Kempen LEM, van Zijl MD, Naaktgeboren CA, Schuit E, Bekedam DJ, Franssen MTM, Nij Bijvank SWA, Sueters M, van Baal M, de Boer MA, Hooker AB, Hermsen BBJ, Toolenaar TAAM, Zwart JJ, van der Ham DP, van der Made FW, Prefumo F, Martinez de Tejada B, Papatsonis DNM, Huisjes AJM, Scheepers LHCJ, van Hoorn ME, Hasaart THM, Schuitemaker NWE, Vollebregt KC, Müller MA, Evers IM, Post MS, de Boer K, Visser H, Mensing van Charante NA, Langenveld J, Steemers NYC, Mol BWJ, Oudijk MA, and Pajkrt E
- Subjects
- Adult, Cervix Uteri pathology, Clinical Protocols, Female, Humans, Infant, Newborn, Pregnancy, Pregnancy Outcome, Treatment Outcome, Young Adult, Cerclage, Cervical methods, Cervical Length Measurement, Pessaries, Premature Birth prevention & control, Uterine Cervical Incompetence therapy
- Published
- 2017
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24. Laparoscopic abdominal cerclage during pregnancy: Report on two cases using a McCartney tube.
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Vissers J, van Kesteren PJ, and Bekedam DJ
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- Adult, Cesarean Section, Female, Gestational Age, Humans, Pregnancy, Premature Birth prevention & control, Cerclage, Cervical instrumentation, Cerclage, Cervical methods, Laparoscopy methods
- Published
- 2017
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25. A multivariable model to guide the decision for pessary placement to prevent preterm birth in women with a multiple pregnancy: a secondary analysis of the ProTWIN trial.
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Tajik P, Monfrance M, van 't Hooft J, Liem SM, Schuit E, Bloemenkamp KW, Duvekot JJ, Nij Bijvank B, Franssen MT, Oudijk MA, Scheepers HC, Sikkema JM, Woiski M, Mol BW, Bekedam DJ, Bossuyt PM, and Zafarmand MH
- Subjects
- Adult, Cervix Uteri, Female, Humans, Multivariate Analysis, Netherlands, Pregnancy, Pregnancy, Multiple, Premature Birth diagnostic imaging, Prenatal Care, Reproducibility of Results, Cervical Length Measurement, Decision Making, Pessaries, Premature Birth prevention & control
- Abstract
Objective: The ProTWIN Trial (NTR1858) showed that, in women with a multiple pregnancy and a cervical length < 25(th) percentile (38 mm), prophylactic use of a cervical pessary reduced the risk of adverse perinatal outcome. We investigated whether other maternal or pregnancy characteristics collected at baseline can improve identification of women most likely to benefit from pessary placement., Methods: ProTWIN is a multicenter randomized trial in which 808 women with a multiple pregnancy were assigned to pessary or control. Using these data we developed a multivariable logistic model comprising treatment, cervical length, chorionicity, pregnancy history and number of fetuses, and the interaction of these variables with treatment as predictors of adverse perinatal outcome., Results: Short cervix, monochorionicity and nulliparity were predictive factors for a benefit from pessary insertion. History of previous preterm birth and triplet pregnancy were predictive factors of possible harm from pessary. The model identified 35% of women as benefiting (95% CI, 32-39%), which is 10% more than using cervical length only (25%) for pessary decisions. The model had acceptable calibration. We estimated that using the model to guide the choice of pessary placement would reduce the risk of adverse perinatal outcome significantly from 13.5% when no pessary is inserted to 8.1% (absolute risk reduction, 5.4% (95% CI, 2.1-8.6%))., Conclusions: We developed and internally validated a multivariable treatment selection model, with cervical length, chorionicity, pregnancy history and number of fetuses. If externally validated, it could be used to identify women with a twin pregnancy who would benefit from a pessary, and lead to a reduction in adverse perinatal outcomes in these women. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd., (Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.)
- Published
- 2016
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26. Pessary placement in the prevention of preterm birth in multiple pregnancies: a propensity score analysis.
- Author
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Monfrance MJ, Schuit E, Groenwold RH, Oudijk MA, de Graaf IM, Bax CJ, Bekedam DJ, Mol BW, and Langenveld J
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- Adult, Asymptomatic Diseases, Bronchopulmonary Dysplasia epidemiology, Cerebral Hemorrhage epidemiology, Cervical Length Measurement, Cohort Studies, Enterocolitis, Necrotizing epidemiology, Female, Humans, Infant, Newborn, Infant, Newborn, Diseases epidemiology, Infant, Premature, Diseases epidemiology, Intensive Care Units, Neonatal statistics & numerical data, Netherlands, Perinatal Death, Pregnancy, Pregnancy, Triplet, Pregnancy, Twin, Propensity Score, Proportional Hazards Models, Prospective Studies, Respiratory Distress Syndrome, Newborn epidemiology, Sepsis epidemiology, Stillbirth epidemiology, Gestational Age, Pessaries, Pregnancy, Multiple, Premature Birth prevention & control
- Abstract
Objective: In asymptomatic women with a multiple pregnancy and short cervix prophylactic use of a cervical pessary might reduce preterm birth. We assessed the possible treatment effects of pessary use in pregnancy duration and for poor perinatal outcome., Study Design: This cohort study was performed between December 2012 and September 2014 in 44 hospitals in the Netherlands. Women with multiple pregnancy had a cervical length measurement between 16 and 22 weeks of gestation. When cervical length was below 38 mm, women were offered a cervical pessary. The course of pregnancy, including perinatal outcome in these women was compared to the outcome of women from the placebo group of the AMPHIA trial (ISRCTN40512715) (historical cohort). Propensity-score matching with replacement was used to create comparable baseline characteristics between both populations., Results: We studied 63 women in the pessary group and 56 women as controls. Propensity-score matching generated 57 women in the intervention group matched to 57 women (31 unique) in the control group. Gestational age at delivery was comparable between both groups (HR 0.96, 95%-CI 0.46-1.46) as well as their delivery rates before 28, 32 and 37 weeks, RR 0.68 (95%-CI 0.21-2.18), RR 0.54 (95%-CI 0.21-1.41), and RR 1.22 (95%-CI 0.47-3.15), respectively. There was no difference in composite perinatal outcome (RR 1.36, 95%-CI 0.53-3.51) and perinatal mortality (RR 0.89, 95%-CI 0.24-3.38) either., Conclusion: In this cohort study with propensity score analysis, pessary use did not prevent preterm birth in asymptomatic women with a multiple pregnancy and short cervix., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)
- Published
- 2016
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27. Second-trimester cervical length as risk indicator for Cesarean delivery in women with twin pregnancy.
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van de Mheen L, Schuit E, Liem SM, Lim AC, Bekedam DJ, Goossens SM, Franssen MT, Porath MM, Oudijk MA, Bloemenkamp KW, Duvekot JJ, Woiski MD, de Graaf I, Sikkema JM, Scheepers HC, van Eijk J, de Groot CJ, van Pampus MG, and Mol BW
- Subjects
- Adult, Female, Humans, Infant, Newborn, Labor, Obstetric, Netherlands epidemiology, Predictive Value of Tests, Pregnancy, Pregnancy Trimester, Second, Randomized Controlled Trials as Topic, Reference Values, Risk Factors, Cervical Length Measurement methods, Cervical Length Measurement statistics & numerical data, Cervix Uteri diagnostic imaging, Cesarean Section statistics & numerical data, Pregnancy Complications diagnostic imaging, Pregnancy, Twin
- Abstract
Objective: To determine whether second-trimester cervical length (CL) in women with a twin pregnancy is associated with the risk of emergency Cesarean section., Methods: This was a secondary analysis of two randomized trials conducted in 57 hospitals in The Netherlands. We assessed the univariable association between risk indicators, including second-trimester CL in quartiles, and emergency Cesarean delivery using a logistic regression model. For multivariable analysis, we assessed whether adjustment for other risk indicators altered the associations found in univariable (unadjusted) analysis. Separate analyses were performed for suspected fetal distress and failure to progress in labor as indications for Cesarean section., Results: In total, 311 women with a twin pregnancy attempted vaginal delivery after 34 weeks' gestation. Emergency Cesarean delivery was performed in 111 (36%) women, of which 67 (60%) were performed owing to arrest of labor. There was no relationship between second-trimester CL and Cesarean delivery (adjusted odds ratio (aOR): 0.97 for CL 26(th) -50(th) percentiles; 0.71 for CL 51(st) - 75(th) percentiles; and 0.92 for CL > 75(th) percentile, using CL ≤ 25(th) percentile as reference). In multivariable analysis, the only variables associated with emergency Cesarean delivery were maternal age (aOR, 1.07 (95% CI, 1.00-1.13)), body mass index (BMI) (aOR, 3.99 (95% CI, 1.07-14.9) for BMI 20-23 kg/m(2) ; 5.04 (95% CI, 1.34-19.03) for BMI 24-28 kg/m(2) ; and 3.1 (95% CI, 0.65-14.78) for BMI > 28 kg/m(2) ) and induction of labor (aOR, 1.92 (95% CI, 1.05-3.5))., Conclusion: In nulliparous women with a twin pregnancy, second-trimester CL is not associated with risk of emergency Cesarean delivery., (Copyright © 2014 ISUOG. Published by John Wiley & Sons Ltd.)
- Published
- 2015
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28. Indicators for Cervical Length in Twin Pregnancies.
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Hermans FJ, Schuit E, Liem SM, Lim AC, Duvekot J, Scheepers LC, Woiski MM, Franssen MM, Oudijk MA, Bloemenkamp KW, Bijvanck BN, Bekedam DJ, Opmeer BC, and Mol BW
- Subjects
- Adult, Female, Humans, Infant, Newborn, Linear Models, Mass Screening, Multivariate Analysis, Netherlands, Pregnancy, Pregnancy Trimester, Second, Reproductive Techniques, Assisted, Cervical Length Measurement, Cervix Uteri diagnostic imaging, Pregnancy, Twin statistics & numerical data, Premature Birth epidemiology
- Abstract
Objective: Cervical length (CL) is associated with the risk of preterm birth (PTB) in multiple pregnancies. However, the position of CL within the pathophysiological pathway of PTB is unclear, and it is unknown which factors are predictive for CL. This study aims to investigate whether in twin pregnancies baseline maternal and obstetrical characteristics are potential indicators for CL, to improve insight in the pathophysiological pathway of PTB., Study Design: Secondary analysis of data on twin pregnancies and CL measurement between 16 and 22 weeks. A set of 10 potential indicators, known to be associated with an increased risk of PTB and/or which have a plausible mechanism resulting in a change of CL were selected. We used multivariable linear regression with backward selection to identify independent indicators for CL., Results: A total of 1,447 women with twin pregnancies were included. Mean CL was 43.7 (±8.9) mm. In multivariable analysis, age (0.27 mm/y; 95% confidence interval [CI] 0.16 to 0.39), use of assisted reproductive technologies (ART) (-1.42 mm, 95% CI -2.6 to -0.25), and having delivered at term in a previous pregnancy (1.32 mm, 95% CI 0.25 to 2.39) were significantly associated with CL., Conclusion: This study shows that in twin pregnancies, age, use of ART and having delivered term in a previous pregnancy has an association with CL., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)
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- 2015
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29. Economic analysis of use of pessary to prevent preterm birth in women with multiple pregnancy (ProTWIN trial).
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Liem SM, van Baaren GJ, Delemarre FM, Evers IM, Kleiverda G, van Loon AJ, Langenveld J, Schuitemaker N, Sikkema JM, Opmeer BC, van Pampus MG, Mol BW, and Bekedam DJ
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- Adult, Cervical Length Measurement drug effects, Cost-Benefit Analysis, Female, Humans, Models, Economic, Pregnancy, Pregnancy Outcome, Pregnancy, Multiple, Premature Birth economics, Prenatal Care methods, Randomized Controlled Trials as Topic, Cervix Uteri drug effects, Pessaries economics, Premature Birth prevention & control, Prenatal Care economics
- Abstract
Objective: To assess the cost-effectiveness of a cervical pessary to prevent preterm delivery in women with a multiple pregnancy., Methods: The study design comprised an economic analysis of data from a randomized clinical trial evaluating cervical pessaries (ProTWIN). Women with a multiple pregnancy were included and an economic evaluation was performed from a societal perspective. Costs were estimated between the time of randomization and 6 weeks postpartum. The prespecified subgroup of women with a cervical length (CL) < 25(th) centile (< 38 mm) was analyzed separately. The primary endpoint was poor perinatal outcome occurring up to 6 weeks postpartum. Direct medical costs and health outcomes were estimated and incremental cost-effectiveness ratios for costs to prevent one poor outcome were calculated., Results: Mean costs in the pessary group (n = 401) were € 21,783 vs € 21,877 in the group in which no pessary was used (n = 407) (difference, -€ 94; 95% CI, -€ 5975 to € 5609). In the prespecified subgroup of women with a CL < 38 mm we demonstrated a significant reduction in poor perinatal outcome (12% vs 29%; RR, 0.40; 95% CI, 0.19-0.83). Mean costs in the pessary group (n = 78) were € 25,141 vs € 30,577 in the no-pessary group (n = 55) (difference, -€ 5436 (95% CI, -€ 11,001 to € 1456). In women with a CL < 38 mm, pessary treatment was the dominant strategy (more effective and less costly) with a probability of 94%., Conclusion: Cervical pessaries in women with a multiple pregnancy involve costs comparable to those in women without pessary treatment. However, in women with a CL < 38 mm, treatment with a cervical pessary appears to be highly cost-effective., (Copyright © 2014 ISUOG. Published by John Wiley & Sons Ltd.)
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- 2014
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30. Haemolytic anaemia after nitrofurantoin treatment in a pregnant woman with G6PD deficiency.
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van de Mheen L, Smits SM, Terpstra WE, Leyte A, Bekedam DJ, and van den Akker ES
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- Adult, Anemia, Hemolytic therapy, Blood Transfusion methods, Cesarean Section methods, Female, Folic Acid therapeutic use, Glucosephosphate Dehydrogenase Deficiency therapy, HELLP Syndrome diagnosis, HELLP Syndrome surgery, Humans, Pregnancy, Pregnancy Outcome, Pregnancy Trimester, Third, Prenatal Care methods, Risk Assessment, Urinary Tract Infections diagnosis, Urinary Tract Infections drug therapy, Vitamin B 12 therapeutic use, Anemia, Hemolytic diagnosis, Glucosephosphate Dehydrogenase Deficiency diagnosis, Nitrofurantoin therapeutic use, Pregnancy Complications, Hematologic diagnosis, Pregnancy Complications, Hematologic therapy
- Abstract
We present a normotensive, pregnant woman with severe haemolytic anaemia in the third trimester of pregnancy. Owing to normal platelet count diagnoses other than HELLP syndrome were considered and investigated. The patient was treated with nitrofurantoin 3 weeks before presentation and she turned out to have a deficiency of glucose-6-phosphate dehydrogenase. After treatment with blood transfusion, vitamin B12 and folic acid the patient recovered completely. Caesarean delivery was performed because of maternal hypertension and fetal distress at 33 weeks' gestation.
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- 2014
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31. Economic analysis comparing induction of labour and expectant management for intrauterine growth restriction at term (DIGITAT trial).
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Vijgen SM, Boers KE, Opmeer BC, Bijlenga D, Bekedam DJ, Bloemenkamp KW, de Boer K, Bremer HA, le Cessie S, Delemarre FM, Duvekot JJ, Hasaart TH, Kwee A, van Lith JM, van Meir CA, van Pampus MG, van der Post JA, Rijken M, Roumen FJ, van der Salm PC, Spaanderman ME, Willekes C, Wijnen EJ, Mol BW, and Scherjon SA
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- Female, Humans, Pregnancy, Fetal Growth Retardation economics, Labor, Induced economics, Randomized Controlled Trials as Topic economics, Watchful Waiting economics
- Abstract
Objective: Pregnancies complicated by intrauterine growth restriction (IUGR) are at increased risk for neonatal morbidity and mortality. The Dutch nationwide disproportionate intrauterine growth intervention trial at term (DIGITAT trial) showed that induction of labour and expectant monitoring were comparable with respect to composite adverse neonatal outcome and operative delivery. In this study we compare the costs of both strategies., Study Design: A cost analysis was performed alongside the DIGITAT trial, which was a randomized controlled trial in which 650 women with a singleton pregnancy with suspected IUGR beyond 36 weeks of pregnancy were allocated to induction or expectant management. Resource utilization was documented by specific items in the case report forms. Unit costs for clinical resources were calculated from the financial reports of participating hospitals. For primary care costs Dutch standardized prices were used. All costs are presented in Euros converted to the year 2009., Results: Antepartum expectant monitoring generated more costs, mainly due to longer antepartum maternal stays in hospital. During delivery and the postpartum stage, induction generated more direct medical costs, due to longer stay in the labour room and longer duration of neonatal high care/medium care admissions. From a health care perspective, both strategies generated comparable costs: on average €7106 per patient for the induction group (N=321) and €6995 for the expectant management group (N=329) with a cost difference of €111 (95%CI: €-1296 to 1641)., Conclusion: Induction of labour and expectant monitoring in IUGR at term have comparable outcomes immediately after birth in terms of obstetrical outcomes, maternal quality of life and costs. Costs are lower, however, in the expectant monitoring group before 38 weeks of gestation and costs are lower in the induction of labour group after 38 weeks of gestation. So if induction of labour is considered to pre-empt possible stillbirth in suspected IUGR, it is reasonable to delay until 38 weeks, with watchful monitoring., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)
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- 2013
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32. Does 17-α-hydroxyprogesterone caproate affect fetal biometry and birth weight in twin pregnancy?
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Mulder EJ, Versteegh EM, Bloemenkamp KW, Lim AC, Mol BW, Bekedam DJ, Kwee A, Bruinse HW, and Christiaens GC
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- 17 alpha-Hydroxyprogesterone Caproate, Adult, Biometry, Female, Gestational Age, Humans, Infant, Newborn, Male, Obstetric Labor, Premature prevention & control, Pregnancy, Pregnancy Trimester, Second, Pregnancy Trimester, Third, Pregnancy, Twin, Risk Factors, Sex Factors, Treatment Outcome, Twins, Birth Weight drug effects, Body Size drug effects, Hydroxyprogesterones pharmacology, Obstetric Labor, Premature drug therapy, Progestins pharmacology
- Abstract
Objective: Increasingly, maternal administration of 17-α-hydroxyprogesterone caproate (17-OHPC) is utilized to prevent preterm birth, but the fetal safety of 17-OHPC is still a matter of concern. This study aimed to assess whether exposure to 17-OHPC during the second and third trimesters of pregnancy affects fetal biometry in twin gestations., Methods: This study included a subset of women with a twin pregnancy who had been previously included in a randomized clinical trial comparing the effectiveness of 17-OHPC and placebo on neonatal outcomes and preterm birth rates in multiple pregnancy. In the present study, the individual growth patterns of femur length, head circumference and abdominal circumference were compared between fetuses of women who had been randomized to receive weekly injections of either 17-OHPC (n = 52) or placebo (n = 58) at between 16-20 and 36 weeks' gestation., Results: The three biometric variables assessed developed similarly in fetuses in both the group exposed to 17-OHPC and the placebo group during the second half of pregnancy. Birth weight adjusted for parity and fetal sex was also comparable between groups., Conclusion: The use of 17-OHPC has no adverse effects on fetal biometry and birth weight in twins., (Copyright © 2013 ISUOG. Published by John Wiley & Sons Ltd.)
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- 2013
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33. Cervical length measurement for the prediction of preterm birth in symptomatic women with a twin pregnancy: a systematic review and meta-analysis.
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Liem SM, van de Mheen L, Bekedam DJ, van Pampus MG, Opmeer BC, Lim AC, and Mol BW
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Objective. The aim of this study was to assess whether cervical length measurement (CL) could predict preterm birth (PTB) in symptomatic women with a twin pregnancy. Methods. We searched MEDLINE and EMBASE to identify studies investigating the accuracy of CL measurement in predicting PTB in symptomatic women with a twin pregnancy. We extracted data to construct two-by-two tables and used bivariate meta-analysis to generate point estimates of sensitivity and specificity. Results. Five studies (N = 226) were included. Variation in definition of PTB and cut-off points for CL was strong. One study investigated delivery within seven days, demonstrating a sensitivity of 1.0 (95% CI: 0.83-1.0) and a specificity of 0.31 (95% CI 0.2-0.43) for a CL cutoff at 25 mm. Three studies reported on predicting PTB < 37 weeks at a CL cutoff of 30 mm, with sROC point estimates of 0.76 (95% CI: 0.66 to 0.84) and 0.37 (95% CI: 0.21 to 0.56) for sensitivity and specificity, respectively. For preterm birth <34 weeks, no pooled estimates could be estimated since only 2 studies with large heterogeneity were identified. Conclusions. There is limited evidence on the accuracy of cervical length measurement testing the prediction of preterm birth in symptomatic women with a twin pregnancy, especially on the most important outcome, that is, delivery within 7 days.
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- 2013
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34. Cervical pessaries for the prevention of preterm birth: a systematic review.
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Liem SM, van Pampus MG, Mol BW, and Bekedam DJ
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Introduction. Reduction of preterm birth is a major goal in obstetric care. We performed a systematic review of randomized controlled trials and cohort studies on the effectiveness of the cervical pessary to prevent preterm birth. Methods. We searched the electronic databases of MEDLINE and Embase from inception until April 2012 to identify studies investigating treatment with a cervical pessary to prevent preterm birth. We constructed two-by-two tables for delivery before 28, 34, and 37 weeks of gestation and calculated relative risks (RRs) with 95% confidence intervals. Results. The search revealed 103 potentially eligible abstracts of which six cohort studies and four randomized controlled trials (RCTs) investigated the effectiveness of the pessary. One RCT (n = 380) demonstrated a lower delivery rate prior to 34 weeks (RR 0.24; 95% CI 0.13-0.43) in the pessary group, while another RCT (n = 108) showed no positive effect of pessary for delivery before 34 weeks (RR 1.73; 95% CI 0.43-6.88). Two older quasi randomized studies and cohort studies indicated potential effect of the pessary. Conclusions. Available randomized and nonrandomized studies indicate potential effectiveness of a cervical pessary in the prevention of preterm birth. More randomized clinical trials are needed before this device can be used in clinical practice.
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- 2013
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35. No effect of the FitFor2 exercise programme on blood glucose, insulin sensitivity, and birthweight in pregnant women who were overweight and at risk for gestational diabetes: results of a randomised controlled trial.
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Oostdam N, van Poppel MN, Wouters MG, Eekhoff EM, Bekedam DJ, Kuchenbecker WK, Quartero HW, Heres MH, and van Mechelen W
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- Adult, Diabetes Mellitus, Type 2 genetics, Diabetes, Gestational blood, Diabetes, Gestational physiopathology, Fasting blood, Female, Gestational Age, Glycated Hemoglobin metabolism, Humans, Overweight blood, Overweight physiopathology, Patient Compliance, Pedigree, Pregnancy, Pregnancy Outcome, Pregnancy Trimester, Second, Pregnancy Trimester, Third, Birth Weight physiology, Blood Glucose metabolism, Diabetes, Gestational prevention & control, Exercise Therapy methods, Insulin Resistance physiology, Overweight therapy
- Abstract
Objective: To evaluate the effectiveness of an exercise programme for pregnant women who were overweight or obese and at risk for gestational diabetes mellitus (GDM)., Design: Randomised controlled trial., Setting: Hospitals and midwifery practices in the Netherlands., Population: Pregnant women who were overweight or obese and at risk for GDM between 2007 and 2011., Methods: Normal care was compared with an exercise training programme during pregnancy. The training consisted of aerobic and strength exercises, and was aimed at improving maternal fasting blood glucose, insulin sensitivity, and birthweight. Linear regression analyses were performed to determine the effects., Main Outcome Measures: Maternal outcome measures were fasting blood glucose (mmol/l), fasting insulin (pmol/l) and HbA1c (%), body weight (kg), body mass index (kg/m(2) ), and daily physical activity (minute/week). Offspring outcome measures were birthweight and fetal growth., Results: A total of 121 women were randomly allocated to either a control (n = 59) or an intervention (n = 62) group. Intention-to-treat analysis showed that the exercise programme did not reduce maternal fasting blood glucose levels nor insulin sensitivity. Also, no effect was found on birthweight., Conclusions: The exercise intervention performed over the second and third trimester of pregnancy had no effects on fasting blood glucose, insulin sensitivity, and birthweight, most probably because of low compliance. The high prevalence of women at risk for GDM calls for further research on possible interventions that can prevent GDM, and other types of interventions to engage this target group in physical activity and exercise., (© 2012 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2012 RCOG.)
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- 2012
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36. Induction versus expectant monitoring for intrauterine growth restriction at term: randomised equivalence trial (DIGITAT).
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Boers KE, Vijgen SM, Bijlenga D, van der Post JA, Bekedam DJ, Kwee A, van der Salm PC, van Pampus MG, Spaanderman ME, de Boer K, Duvekot JJ, Bremer HA, Hasaart TH, Delemarre FM, Bloemenkamp KW, van Meir CA, Willekes C, Wijnen EJ, Rijken M, le Cessie S, Roumen FJ, Thornton JG, van Lith JM, Mol BW, and Scherjon SA
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- Adult, Female, Gestational Age, Humans, Labor Onset, Length of Stay, Pregnancy, Pregnancy Outcome, Young Adult, Fetal Growth Retardation therapy, Labor, Induced, Watchful Waiting
- Abstract
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' gestation with suspected intrauterine growth restriction., Interventions: Induction of labour or expectant monitoring., Main Outcome Measures: The primary outcome was a composite measure of adverse neonatal outcome, defined as death before hospital discharge, five minute Apgar score of less than 7, umbilical artery pH of less than 7.05, or admission to the intensive care unit. Operative delivery (vaginal instrumental delivery or caesarean section) was a secondary outcome. Analysis was by intention to treat, with confidence intervals calculated for the differences in percentages or means., Results: 321 pregnant women were randomly allocated to induction and 329 to expectant monitoring. Induction group infants were delivered 10 days earlier (mean difference -9.9 days, 95% CI -11.3 to -8.6) and weighed 130 g less (mean difference -130 g, 95% CI -188 g to -71 g) than babies in the expectant monitoring group. A total of 17 (5.3%) infants in the induction group experienced the composite adverse neonatal outcome, compared with 20 (6.1%) in the expectant monitoring group (difference -0.8%, 95% CI -4.3% to 3.2%). Caesarean sections were performed on 45 (14.0%) mothers in the induction group and 45 (13.7%) in the expectant monitoring group (difference 0.3%, 95% CI -5.0% to 5.6%)., Conclusions: In women with suspected intrauterine growth restriction at term, we found no important differences in adverse outcomes between induction of labour and expectant monitoring. Patients who are keen on non-intervention can safely choose expectant management with intensive maternal and fetal monitoring; however, it is rational to choose induction to prevent possible neonatal morbidity and stillbirth., Trial Registration: International Standard Randomised Controlled Trial number ISRCTN10363217.
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- 2010
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37. Induction of labour versus expectant monitoring for gestational hypertension or mild pre-eclampsia after 36 weeks' gestation (HYPITAT): a multicentre, open-label randomised controlled trial.
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Koopmans CM, Bijlenga D, Groen H, Vijgen SM, Aarnoudse JG, Bekedam DJ, van den Berg PP, de Boer K, Burggraaff JM, Bloemenkamp KW, Drogtrop AP, Franx A, de Groot CJ, Huisjes AJ, Kwee A, van Loon AJ, Lub A, Papatsonis DN, van der Post JA, Roumen FJ, Scheepers HC, Willekes C, Mol BW, and van Pampus MG
- Subjects
- Abruptio Placentae epidemiology, Adult, Eclampsia epidemiology, Female, Gestational Age, HELLP Syndrome epidemiology, Humans, Hypertension, Pregnancy-Induced epidemiology, Logistic Models, Maternal Mortality, Netherlands epidemiology, Patient Selection, Postpartum Hemorrhage epidemiology, Pre-Eclampsia epidemiology, Pregnancy, Pregnancy Outcome epidemiology, Pulmonary Edema epidemiology, Severity of Illness Index, Statistics, Nonparametric, Thromboembolism epidemiology, Fetal Monitoring methods, Hypertension, Pregnancy-Induced therapy, Labor, Induced methods, Pre-Eclampsia therapy
- Abstract
Background: Robust evidence to direct management of pregnant women with mild hypertensive disease at term is scarce. We investigated whether induction of labour in women with a singleton pregnancy complicated by gestational hypertension or mild pre-eclampsia reduces severe maternal morbidity., Methods: We undertook a multicentre, parallel, open-label randomised controlled trial in six academic and 32 non-academic hospitals in the Netherlands between October, 2005, and March, 2008. We enrolled patients with a singleton pregnancy at 36-41 weeks' gestation, and who had gestational hypertension or mild pre-eclampsia. Participants were randomly allocated in a 1:1 ratio by block randomisation with a web-based application system to receive either induction of labour or expectant monitoring. Masking of intervention allocation was not possible. The primary outcome was a composite measure of poor maternal outcome--maternal mortality, maternal morbidity (eclampsia, HELLP syndrome, pulmonary oedema, thromboembolic disease, and placental abruption), progression to severe hypertension or proteinuria, and major post-partum haemorrhage (>1000 mL blood loss). Analysis was by intention to treat and treatment effect is presented as relative risk. This study is registered, number ISRCTN08132825., Findings: 756 patients were allocated to receive induction of labour (n=377 patients) or expectant monitoring (n=379). 397 patients refused randomisation but authorised use of their medical records. Of women who were randomised, 117 (31%) allocated to induction of labour developed poor maternal outcome compared with 166 (44%) allocated to expectant monitoring (relative risk 0.71, 95% CI 0.59-0.86, p<0.0001). No cases of maternal or neonatal death or eclampsia were recorded., Interpretation: Induction of labour is associated with improved maternal outcome and should be advised for women with mild hypertensive disease beyond 37 weeks' gestation., Funding: ZonMw.
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- 2009
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38. Pessaries in multiple pregnancy as a prevention of preterm birth: the ProTwin Trial.
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Hegeman MA, Bekedam DJ, Bloemenkamp KW, Kwee A, Papatsonis DN, van der Post JA, Lim AC, Scheepers HC, Willekes C, Duvekot JJ, Spaanderman M, Porath M, van Eyck J, Haak MC, van Pampus MG, Bruinse HW, and Mol BW
- Subjects
- Cervical Length Measurement, Clinical Protocols, Cost-Benefit Analysis, Female, Humans, Netherlands, Outcome Assessment, Health Care, Pessaries economics, Pregnancy, Pregnancy Trimester, Second, Research Design, Treatment Outcome, Twins, Pregnancy, Multiple, Premature Birth prevention & control
- Abstract
Background: Multiple pregnancies are at high risk for preterm birth, and therefore an important cause of infant mortality and morbidity. A pessary is a simple and potentially effective measure for the prevention of preterm birth. Small studies have indicated its effectiveness, but large studies with sufficient power on the subject are lacking. Despite this lack of evidence, the treatment is at present applied by some gynaecologists in The Netherlands., Methods/design: We aim to investigate the hypothesis that prophylactic use of a cervical pessary will be effective in the prevention of preterm delivery and the neonatal mortality and morbidity resulting from preterm delivery in multiple pregnancy. We will evaluate the costs and effects of this intervention. At study entry, cervical length will be measured. Eligible women will be randomly allocated to receive either a cervical pessary or no intervention. The cervical pessary will be placed in situ at 16 to 20 weeks, and will stay in situ up to 36 weeks gestation or until delivery, whatever comes first.The primary outcome is composite bad neonatal condition (perinatal death or severe morbidity). Secondary outcome measures are time to delivery, preterm birth rate before 32 and 37 weeks, days of admission in neonatal intensive care unit, maternal morbidity, maternal admission days for preterm labour and costs. We need to include 660 women to indicate a reduction in bad neonatal outcome from 7.2% without to 3.9% with a cervical pessary, using a two-sided test with an alpha of 0.05 and a power of 0.80., Discussion: This trial will provide evidence on whether a cervical pessary will decrease the incidence of early preterm birth and its concomitant bad neonatal outcome in multiple pregnancies., Trial Registration: Current Controlled Trials: NTR 1858.
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- 2009
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39. Maternal temperature during labour.
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Schouten FD, Wolf H, Smit BJ, Bekedam DJ, de Vos R, and Wahlen I
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- Adult, Analysis of Variance, Circadian Rhythm physiology, Cohort Studies, Female, Humans, Body Temperature physiology, Labor, Obstetric physiology, Pregnancy physiology
- Abstract
Objective: The aim of this study was to describe the variation of normal maternal temperature during labour. Design A prospective cohort study., Setting: Two hospitals in Amsterdam, the Netherlands., Population: All women with a live singleton pregnancy and a gestational age of 36 weeks or more admitted to the delivery ward from June 2000 to January 2002., Methods: Maternal temperature was measured rectally every 2-3 hours from admission until the beginning of second stage, and 1-hour postpartum. Normal labour (n = 843) was defined as gestational age > or =37 weeks, spontaneous onset of labour, rupture of membranes <18 hours before birth, normal progress of labour without the need for augmentation or epidural analgesia and spontaneous vaginal delivery of a healthy infant. The remaining group was classified as abnormal (n = 2209)., Main Outcome Measures: Rectal measured temperature in degrees Celsius., Results: The mean temperature during labour in the complete study population increased from 37.1 degrees C at the beginning of labour to 37.4 degrees C after 22 hours. Temperature in the abnormal labour group was equal to the normal labour group during the first 3 hours of labour (P > 0.05) but increased thereafter., Conclusions: At the beginning of labour, temperature was 37.1 degrees C. Temperature increased slowly during labour and was 37.4 degrees C (2SD 1.2) after 22 hours. The upper 2SD limit for normal temperature did not follow a circadian pattern and time of day is not relevant for the classification of normal versus elevated temperature.
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- 2008
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40. Induction of labour versus expectant monitoring in women with pregnancy induced hypertension or mild preeclampsia at term: the HYPITAT trial.
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Koopmans CM, Bijlenga D, Aarnoudse JG, van Beek E, Bekedam DJ, van den Berg PP, Burggraaff JM, Birnie E, Bloemenkamp KW, Drogtrop AP, Franx A, de Groot CJ, Huisjes AJ, Kwee A, le Cessie S, van Loon AJ, Mol BW, van der Post JA, Roumen FJ, Scheepers HC, Spaanderman ME, Stigter RH, Willekes C, and van Pampus MG
- Subjects
- Adult, Confidence Intervals, Female, Humans, Infant Welfare, Infant, Newborn, Maternal Welfare, Multicenter Studies as Topic, Pregnancy, Quality of Life, Randomized Controlled Trials as Topic, Hypertension, Pregnancy-Induced therapy, Labor, Induced methods, Pre-Eclampsia therapy, Pregnancy Outcome, Research Design, Term Birth
- Abstract
Background: Hypertensive disorders, i.e. pregnancy induced hypertension and preeclampsia, complicate 10 to 15% of all pregnancies at term and are a major cause of maternal and perinatal morbidity and mortality. The only causal treatment is delivery. In case of preterm pregnancies conservative management is advocated if the risks for mother and child remain acceptable. In contrast, there is no consensus on how to manage mild hypertensive disease in pregnancies at term. Induction of labour might prevent maternal and neonatal complications at the expense of increased instrumental vaginal delivery rates and caesarean section rates., Methods/design: Women with a pregnancy complicated by pregnancy induced hypertension or mild preeclampsia at a gestational age between 36+0 and 41+0 weeks will be asked to participate in a multi-centre randomised controlled trial. Women will be randomised to either induction of labour or expectant management for spontaneous delivery. The primary outcome of this study is severe maternal morbidity, which can be complicated by maternal mortality in rare cases. Secondary outcome measures are neonatal mortality and morbidity, caesarean and vaginal instrumental delivery rates, maternal quality of life and costs. Analysis will be by intention to treat. In total, 720 pregnant women have to be randomised to show a reduction in severe maternal complications of hypertensive disease from 12 to 6%., Discussion: This trial will provide evidence as to whether or not induction of labour in women with pregnancy induced hypertension or mild preeclampsia (nearly) at term is an effective treatment to prevent severe maternal complications., Trial Registration: The protocol is registered in the clinical trial register number ISRCTN08132825.
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- 2007
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41. Disproportionate Intrauterine Growth Intervention Trial At Term: DIGITAT.
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Boers KE, Bijlenga D, Mol BW, LeCessie S, Birnie E, van Pampus MG, Stigter RH, Bloemenkamp KW, van Meir CA, van der Post JA, Bekedam DJ, Ribbert LS, Drogtrop AP, van der Salm PC, Huisjes AJ, Willekes C, Roumen FJ, Scheepers HC, de Boer K, Duvekot JJ, Thornton JG, and Scherjon SA
- Subjects
- Adult, Confidence Intervals, Costs and Cost Analysis, Female, Fetal Growth Retardation epidemiology, Humans, Infant Welfare statistics & numerical data, Infant, Newborn, Labor, Induced methods, Maternal Welfare statistics & numerical data, Pregnancy, Pregnancy Outcome epidemiology, Prospective Studies, Quality of Life, Fetal Growth Retardation economics, Infant Welfare economics, Labor, Induced economics, Maternal Welfare economics, Pregnancy Outcome economics, Term Birth
- Abstract
Background: Around 80% of intrauterine growth restricted (IUGR) infants are born at term. They have an increase in perinatal mortality and morbidity including behavioral problems, minor developmental delay and spastic cerebral palsy. Management is controversial, in particular the decision whether to induce labour or await spontaneous delivery with strict fetal and maternal surveillance. We propose a randomised trial to compare effectiveness, costs and maternal quality of life for induction of labour versus expectant management in women with a suspected IUGR fetus at term., Methods/design: The proposed trial is a multi-centre randomised study in pregnant women who are suspected on clinical grounds of having an IUGR child at a gestational age between 36+0 and 41+0 weeks. After informed consent women will be randomly allocated to either induction of labour or expectant management with maternal and fetal monitoring. Randomisation will be web-based. The primary outcome measure will be a composite neonatal morbidity and mortality. Secondary outcomes will be severe maternal morbidity, maternal quality of life and costs. Moreover, we aim to assess neurodevelopmental and neurobehavioral outcome at two years as assessed by a postal enquiry (Child Behavioral Check List-CBCL and Ages and Stages Questionnaire-ASQ). Analysis will be by intention to treat. Quality of life analysis and a preference study will also be performed in the same study population. Health technology assessment with an economic analysis is part of this so called Digitat trial (Disproportionate Intrauterine Growth Intervention Trial At Term). The study aims to include 325 patients per arm., Discussion: This trial will provide evidence for which strategy is superior in terms of neonatal and maternal morbidity and mortality, costs and maternal quality of life aspects. This will be the first randomised trial for IUGR at term., Trial Registration: Dutch Trial Register and ISRCTN-Register: ISRCTN10363217.
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- 2007
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42. [Spontaneous liver haemorrhage during pregnancy: a rare and life-threatening situation].
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Boormans EM, Bekedam DJ, Lenters E, Schoonderbeek FJ, and Tilanus HW
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- Abdominal Pain etiology, Adult, Edema etiology, Female, HELLP Syndrome, Hematoma complications, Hematoma diagnostic imaging, Hematoma surgery, Hemorrhage complications, Hemorrhage surgery, Humans, Infant, Newborn, Liver Diseases complications, Liver Diseases surgery, Pre-Eclampsia diagnosis, Pre-Eclampsia surgery, Pregnancy, Pregnancy Complications surgery, Radiography, Rupture, Spontaneous complications, Rupture, Spontaneous diagnosis, Shock, Hemorrhagic etiology, Cesarean Section, Hemorrhage diagnosis, Liver Diseases diagnosis, Pregnancy Complications diagnosis, Pregnancy Outcome
- Abstract
Three pregnant women, of whom 2 were 33 and 1 was 35 years of age, were seen; 2 of them had upper abdominal pain and 1had oedema. All had proteinuria and liver enzyme abnormalities, and pre-eclampsia or the HELLP syndrome was suspected. They were consequently admitted and at first treated with antihypertensive agents. One patient underwent a Caesarean section and the baby had a good start. Afterwards, however, the patient developed shock. A CT-scan revealed a hepatic rupture, for which repeated surgical packing of the liver was carried out. The postoperative course was complicated. A second patient developed shock and the foetus died. Here the CT-scan revealed a liver haematoma. At surgery the next day, removal of the foetus was followed by heavy uterine bleeding. The patient again developed shock and the uterus was resected. A haematoma that was seen in the liver was treated expectatively. The postoperative course was not complicated. In a third patient, abdominal echography revealed bleeding from the liver. Simultaneous Caesarean section and surgical exploration of the liver took place, with packing of the liver. The child had Apgar scores of 4, 7 and 9. After re-laparotomy because of persistent bleeding from the liver the patient recovered. Spontaneous liver haemorrhage and hepatic rupture during pregnancy is a rare condition associated with significant maternal and perinatal mortality. The majority of cases occur during pregnancies complicated by pre-eclampsia or the HELLP syndrome. The presenting symptoms are non-specific. A high index of suspicion is important and early evaluation with imaging is necessary to improve the prognosis of both mother and child.
- Published
- 2007
43. Relationship between gestational diabetes mellitus and type 2 diabetes: evidence of mitochondrial dysfunction.
- Author
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Weijers RN and Bekedam DJ
- Subjects
- Adult, C-Peptide blood, Cross-Sectional Studies, Diabetes Mellitus, Type 1 physiopathology, Diabetes Mellitus, Type 2 ethnology, Diabetes, Gestational ethnology, Female, Glucose Tolerance Test, Humans, Netherlands, Pregnancy, Diabetes Mellitus, Type 2 physiopathology, Diabetes, Gestational physiopathology, Mitochondria physiology
- Abstract
Background: We examined the pathogenesis of gestational diabetes mellitus (GDM) in a large Dutch multiethnic cohort., Methods: We used a 2-step testing procedure to stratify 2031 consecutive pregnant women into 4 groups according to American Diabetes Association criteria: (a) normal glucose tolerance (NGT), (b) mild gestational hyperglycemia (MGH), (c) GDM without early postpartum diabetes within 6 months of delivery (GDM1), and (d) GDM with early postpartum diabetes (GDM2). Antepartum and postpartum clinical characteristics and measures of glucose tolerance were documented., Results: Overall, 1627 women had NGT, 237 had MGH, 156 had GDM1, and 11 had GDM2. Prepregnancy body mass index values progressively increased from NGT to MGH to GDM1. The fasting plasma glucose concentration, the 100-g oral glucose tolerance test (OGTT) area under the curve, and the mean glucose concentration during the OGTT all increased progressively among the 4 groups. The fasting C-peptide concentration displayed an inverted-U pattern, with a maximum at a mean plasma glucose concentration during the OGTT of 9.6 mmol/L in the transition from GDM1 to GDM2. The fasting C-peptide/glucose concentration ratio decreased by 42% in GDM patients compared with NGT patients, whereas the ratios in MGH and NGT women were similar., Conclusions: Progressive metabolic derangement of glucose tolerance 1st detected during pregnancy mimics the pathogenesis of type 2 diabetes. In addition, our results imply an impaired basal glucose effectiveness in the early prediabetic state. To explain the parallel in both metabolic derangements, we postulate that GDM, like type 2 diabetes, is attributable to the same inherited mitochondrial dysfunction.
- Published
- 2007
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44. The clinical usefulness of glucose tolerance testing in gestational diabetes to predict early postpartum diabetes mellitus.
- Author
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Weijers RN, Bekedam DJ, Goldschmidt HM, and Smulders YM
- Subjects
- Adult, Blood Glucose metabolism, Cohort Studies, Diabetes, Gestational blood, Ethnicity, Female, Gestational Age, Humans, Middle Aged, Netherlands, Pregnancy, ROC Curve, Time Factors, Diabetes, Gestational diagnosis, Glucose Tolerance Test methods, Postpartum Period blood
- Abstract
We examined the clinical usefulness of antepartum clinical characteristics, along with measures of glucose tolerance, in Dutch multiethnic women with gestational diabetes mellitus (GDM) for their ability to predict type 2 diabetes within 6 months of delivery (early postpartum diabetes). The present study comprised a cross-sectional 5-year investigation (1998-2003) of a consecutive series of 168 women with GDM identified by a two-stage protocol at 16-33 weeks of gestation. The following data were collected for all women: age and gestational age at entry into the study; prepregnancy body mass index (BMI); ethnicity; obstetric and clinical history, including the onset of early postpartum diabetes; pregnancy outcome; level of fasting C-peptide; and glycemic parameters of 50-g 1-h glucose challenge test and 100-g 3-h oral glucose tolerance test (diagnostic OGTT). We used receiver operating characteristic (ROC) curve analysis to test the clinical usefulness of the glycemic parameters. A total of 11 women (6.5%) developed early postpartum diabetes. Apart from family history of diabetes (p = 0.052), anthropometric, maternal, and neonatal clinical parameters showed no association with early postpartum diabetes in univariate analyses. The level of fasting glucose, and both the glucose challenge test and diagnostic OGTT post-load glucose levels and glucose areas were associated with early postpartum diabetes. ROC curve analysis identifiedall three glucose challenge-test parameters, including fasting glucose concentration, as poor diagnostic tests, with a positive predictive value of approximately 22%, whereas the positive predictive value associated with the area under the diagnostic OGTT curve increased progressively over monitoring time from 20.6% to 100%. Using a 3-h OGTT glucose area threshold of 35.7 mmol.h/L resulted in 100% sensitivity and 100% specificity, identifying the 11 women who developed early postpartum diabetes. In summary, we can conclude from the present analysis that early postpartum diabetes is rare in GDM women (6.5%), and that the clinical usefulness of the total area under the diagnostic 3-h OGTT is superior to all other glycemic parameters for detecting early postpartum diabetes.
- Published
- 2006
- Full Text
- View/download PDF
45. Male predominance in fetal distress during labor.
- Author
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Bekedam DJ, Engelsbel S, Mol BW, Buitendijk SE, and van der Pal-de Bruin KM
- Subjects
- Apgar Score, Asphyxia Neonatorum epidemiology, Birth Weight, Cohort Studies, Delivery, Obstetric methods, Female, Gestational Age, Humans, Infant, Newborn, Logistic Models, Male, Netherlands, Odds Ratio, Pregnancy, Prospective Studies, Fetal Distress epidemiology, Labor, Obstetric, Sex Characteristics
- Abstract
Objective: The purpose of this study was to assess the association between fetal sex and the occurrence of fetal distress during labor., Study Design: This was a prospective cohort study that incorporated data about 423,033 singleton pregnancies from the national perinatal database for secondary obstetric care in The Netherlands. All singleton pregnancies on record that were delivered under the responsibility of obstetricians in The Netherlands between January 1, 1990, and December 31, 1994, were analyzed. Data about fetal sex, gestational age at delivery, birth weight, fetal distress during labor, mode of delivery, signs of asphyxia at birth, and perinatal death were collected. The associations between sex and the occurrence of operative delivery for fetal distress, low 5-minute Apgar score (score, 0-3), and perinatal death were evaluated by logistic regression analysis., Results: Male fetuses are at increased risk for fetal distress during labor, for low Apgar scores, and for perinatal death. After adjustment for fetal birth weight and gestational age at delivery, the odds ratios were 1.48, 1.27, and 1.27, respectively. All three associations were highly statistically significant (P <.0001)., Conclusion: Male fetuses are at increased risk during labor and delivery.
- Published
- 2002
- Full Text
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46. Determinants of mild gestational hyperglycemia and gestational diabetes mellitus in a large dutch multiethnic cohort.
- Author
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Weijers RN, Bekedam DJ, and Smulders YM
- Subjects
- Adult, Apgar Score, Blood Glucose metabolism, Body Mass Index, C-Peptide blood, Diabetes, Gestational epidemiology, Ethnicity, Family, Fasting, Female, Gestational Age, Glucose Tolerance Test, Humans, Hyperglycemia epidemiology, Hypertension physiopathology, Infant, Newborn, Maternal Age, Netherlands epidemiology, Parity, Pregnancy, Pregnancy Complications epidemiology, Pregnancy Complications, Cardiovascular physiopathology, Pregnancy, High-Risk, Reference Values, White People, Diabetes, Gestational physiopathology, Hyperglycemia physiopathology, Pregnancy Complications physiopathology
- Abstract
Objective: The purpose of this study was to identify independent determinants of mild gestational hyperglycemia (MGH) and gestational diabetes mellitus (GDM) and to assess the correlation between fasting glucose and C-peptide levels among control, MGH, and GDM women., Research Design and Methods: A total of 1,022 consecutive women were evaluated with a 1-h 50-g glucose challenge test (GCT) at between 16 and 33 weeks of gestation. Women with a capillary whole-blood glucose > or =7.8 mmol/l in the GCT underwent a 3-h 100-g oral glucose tolerance test (OGTT). On the basis of a positive GCT, the women with a positive OGTT were classified as GDM, whereas the women with a negative OGTT were classified as MGH. The following data were collected for all women: age, prepregnancy BMI, ethnicity, clinical and obstetric history, pregnancy outcome, and C-peptide level., Results: A total of 813 women (79.6%) were normal, 138 (13.5%) had MGH, and 71 (6.9%) had GDM. There was a stepwise significant increase in mean fasting glucose (3.6 +/- 0.4, 3.9 +/- 0.4, and 4.7 +/- 0.7 mmol/l, respectively) and C-peptide level (0.60 [0.1-2.4], 0.86 [0.3-2.0], and 1.00 [0.5-1.6] nmol/l, respectively) among the three diagnostic groups. Maternal age, non-Caucasian ethnicity, and prepregnancy BMI were associated with GDM, whereas only maternal age and prepregnancy BMI were associated with MGH. A positive correlation between levels of fasting glucose and C-peptide was found in control women (r = 0.39 [95% CI 0.31-0.46]). A similar result was seen in MGH women (r = 0.38 [95% CI 0.23-0.52]), whereas the correlation between fasting glucose and C-peptide was nearly lost in GDM women (r = 0.14 [CI -0.09 to 0.36]). The fasting C-peptide-to-glucose ratio was reduced by 60% in GDM patients versus control subjects and MGH patients (0.41 +/- 0.25 vs. 0.70 +/- 0.20 and 0.73 +/- 0.23, P < 0.001)., Conclusions: Of the well-known independent determinants of GDM, only maternal age and prepregnancy BMI were associated with MGH. It appears that additional factors promoting loss of beta-cell function distinguish MGH from GDM. One of these factors appears to be ethnicity.
- Published
- 2002
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- View/download PDF
47. Final results of the Cervical Incompetence Prevention Randomized Cerclage Trial (CIPRACT): therapeutic cerclage with bed rest versus bed rest alone.
- Author
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Althuisius SM, Dekker GA, Hummel P, Bekedam DJ, and van Geijn HP
- Subjects
- Cervix Uteri diagnostic imaging, Female, Humans, Incidence, Infant, Newborn, Infant, Newborn, Diseases prevention & control, Obstetric Labor, Premature epidemiology, Obstetric Labor, Premature prevention & control, Pregnancy, Risk Factors, Ultrasonography, Uterine Cervical Incompetence etiology, Bed Rest, Cerclage, Cervical, Cervix Uteri surgery, Uterine Cervical Incompetence prevention & control
- Abstract
Objective: To compare preterm delivery rates (before 34 weeks of gestation) and neonatal morbidity and mortality in patients with risk factors or symptoms of cervical incompetence managed with therapeutic McDonald cerclage and bed rest versus bed rest alone., Study Design: Cervical length was measured in patients with risk factors or symptoms of cervical incompetence. Risk factors for cervical incompetence included previous preterm delivery before 34 weeks of gestation that met clinical criteria for the diagnosis of cervical incompetence, previous preterm premature rupture of membranes before 32 weeks of gestation, history of cold knife conization, diethylstilbestrol exposure, and uterine anomaly. When a cervical length of <25 mm was measured before a gestational age of 27 weeks, a randomization for therapeutic cerclage and bed rest (cerclage group) or bed rest alone (bed rest group) was performed. The analysis is based on intention to treat., Results: Of the 35 women who met the inclusion criteria, 19 were allocated randomly to the cerclage group and 16 to the bed rest group. Both groups were comparable for mean cervical length and mean gestational age at time of randomization, mean overall 20 mm and 21 weeks. Preterm delivery before 34 weeks was significantly more frequent in the bed rest group than in the cerclage group (7 of 16 vs none, respectively; P =.002). There was no statistically significant difference in neonatal survival between the groups (13 neonates survived in the bed rest group vs all in the cerclage group). The compound neonatal morbidity, defined as admission to the neonatal intensive care unit or neonatal death, was significantly higher in the bed rest group than in the cerclage group (8 of 16 vs 1 of 19, respectively; P =.005; RR = 9.5, 95% CI, 1.3-68.1)., Conclusions: Therapeutic cerclage with bed rest reduces preterm delivery before 34 weeks of gestation and compound neonatal morbidity in women with risk factors and/or symptoms of cervical incompetence and a cervical length of <25 mm before 27 weeks of gestation.
- Published
- 2001
- Full Text
- View/download PDF
48. Cervical incompetence prevention randomized cerclage trial (CIPRACT): study design and preliminary results.
- Author
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Althuisius SM, Dekker GA, van Geijn HP, Bekedam DJ, and Hummel P
- Subjects
- Cervix Uteri diagnostic imaging, Female, Humans, Incidence, Obstetric Labor, Premature epidemiology, Obstetric Labor, Premature prevention & control, Pregnancy, Research Design, Ultrasonography, Cervix Uteri surgery, Obstetric Surgical Procedures, Suture Techniques, Uterine Cervical Incompetence prevention & control
- Abstract
Objective: The objective of this study was to compare different management strategies for women at risk for cervical incompetence., Study Design: In an ongoing randomized trial patients with a previous preterm delivery at <34 weeks' gestation who met clinical criteria for the diagnosis of cervical incompetence are allocated to receive a prophylactic cerclage (prophylactic cerclage group) or not (observational group) in a proportion of 1:2. Transvaginal ultrasonographic follow-up examination of the cervix is performed in both groups. When a patient of the latter group has a cervical length <25 mm at <27 weeks' gestation, a further random assignment of therapeutic cerclage or no cerclage is performed. The analysis is by intent to treat., Results: Primary random assignment allocated 23 women to the prophylactic cerclage group and 44 to the observational group. Both groups were comparable with respect to obstetric history. No significant difference was found between the prophylactic cerclage group and the observational group in preterm delivery at <34 weeks' gestation (3/23 vs 6/44, respectively) and neonatal survival (21/23 vs 41/44, respectively). A cervical length <25 mm was found in 18 patients (41%) in the observational group at a mean gestational age of 19.1 +/- 2.9 weeks' gestation. Incidence of preterm delivery at <34 weeks' gestation was significantly higher in the group with short cervical length (6/18 vs 0/26; P =.003). Secondary random assignment of the 18 patients with short cervical length allocated 10 to undergo therapeutic cerclage. Preterm delivery at <34 weeks' gestation was significantly less frequent in the therapeutic cerclage group (1/10 vs 5/8)., Conclusion: Transvaginal ultrasonographic serial follow-up examinations of the cervix in women at risk for cervical incompetence, with secondary intervention as indicated, appears to be a safe alternative to the traditional prophylactic cerclage. Transvaginal ultrasonographic follow-up examination of the cervix can save the majority of women from unnecessary intervention. Placement of a therapeutic cerclage may reduce the incidence of preterm delivery at <34 weeks' gestation among high-risk patients.
- Published
- 2000
- Full Text
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49. The prevalence of type 2 diabetes and gestational diabetes mellitus in an inner city multi-ethnic population.
- Author
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Weijers RN, Bekedam DJ, and Oosting H
- Subjects
- Adult, Aged, Diabetes Mellitus, Type 2 ethnology, Diabetes, Gestational ethnology, Female, Humans, Male, Middle Aged, Netherlands epidemiology, Population Surveillance, Pregnancy, Prevalence, Urban Population, Diabetes Mellitus, Type 2 epidemiology, Diabetes, Gestational epidemiology
- Abstract
Zeeburg', a multiethnic town borough in the Amsterdam-East region, has one of the city's highest rates of immigrants. In the total population of 19,825 Surinam (mainly Creole), Turkish, Moroccan, and Dutch adults the prevalence of known type 2 diabetes in 1994 and of gestational diabetes mellitus (GDM) between January 1992 and January 1997 was investigated. Based on World Health Organization (WHO) criteria of 1985, the age-standardized prevalence of type 2 diabetes was similar in men (6.4%; 95% confidence interval [CI]: 5.6-7.2) and women (6.4%: 95% CI: 5.8-7.0) for all ethnic groups combined. However, the age- and sex-standardized prevalence of type 2 diabetes was significantly greater in the non-Dutch inhabitants than in the Dutch inhabitants (17.3% [95% CI: 12.9-21.6] in Surinam inhabitants, 10.9% [95% CI: 9.7-12.2] in Turkish inhabitants, 12.4% [95% CI: 9.7-15.0] in Moroccan inhabitants, and 3.6% [95% CI: 3.2-3.9] in Dutch inhabitants). The odds ratios for type 2 diabetes for the separate immigrant groups relative to the Dutch group were 5.88 (95% CI: 4.54-7.69) for Surinam inhabitants, 4.00 (95% CI: 2.86-5.55) for Turkish inhabitants, and 4.17 (95% CI: 3.03-5.55) for Moroccan inhabitants. GDM was present in 2.59% of women of non-Dutch origin compared with 0.62% of women of Dutch origin. A significant positive association was found between the non-Dutch origin and the occurrence of GDM (chi2 = 6.7; p < 0.01). The study highlights a high prevalence of known type 2 diabetes and GDM in the immigrant inhabitants and emphasizes that appropriate interventions are necessarily with implications for health targets and capitation based budgets.
- Published
- 1998
- Full Text
- View/download PDF
50. Prenatal diagnosis in two cases of de novo complex balanced chromosomal rearrangements. Three-year follow-up in one case.
- Author
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Sikkema-Raddatz B, Sijmons RH, Tan-Sindhunata MB, van der Veen AY, Brunsting R, de Vries B, Beekhuis JR, Bekedam DJ, van Aken B, and de Jong B
- Subjects
- Adult, Amniocentesis, Chorionic Villi Sampling, Female, Follow-Up Studies, Humans, In Situ Hybridization, Fluorescence, Karyotyping, Male, Maternal Age, Pregnancy, Pregnancy, High-Risk, Chromosome Aberrations, Prenatal Diagnosis
- Abstract
We report two cases of apparently balanced complex de novo chromosomal rearrangements (BCCR) detected prenatally at 17 weeks and 10 weeks of gestation, respectively. Chromosomes were studied using GTG-banding and fluorescent in situ hybridization (FISH). In one case four chromosomes and in the other case three chromosomes were involved in the rearrangements. One of the pregnancies was terminated and no external or internal showed no abnormalities. The child is now 3 years old and has neither congenital anomalies nor evidence of delayed psychomotor development.
- Published
- 1995
- Full Text
- View/download PDF
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