340 results on '"Gerard H. A. Visser"'
Search Results
2. Global disparities in caesarean section rates: Why indication-based metrics are needed.
- Author
-
Mehreen Zaigham, John Varallo, Shakila Thangaratinam, Wanda Nicholson, and Gerard H A Visser
- Subjects
Public aspects of medicine ,RA1-1270 - Published
- 2024
- Full Text
- View/download PDF
3. Hemolytic disease of the fetus and newborn due to Rh(D) incompatibility: A preventable disease that still produces significant morbidity and mortality in children.
- Author
-
Valeria Pegoraro, Ducciocompet Urbinati, Gerard H A Visser, Gian Carlo Di Renzo, Alvin Zipursky, Brie A Stotler, and Steven L Spitalnik
- Subjects
Medicine ,Science - Abstract
In the mid-20th century, Hemolytic Disease of the Fetus and Newborn, caused by maternal alloimmunization to the Rh(D) blood group antigen expressed by fetal red blood cells (i.e., "Rh disease"), was a major cause of fetal and neonatal morbidity and mortality. However, with the regulatory approval, in 1968, of IgG anti-Rh(D) immunoprophylaxis to prevent maternal sensitization, the prospect of eradicating Rh disease was at hand. Indeed, the combination of antenatal and post-partum immunoprophylaxis is ~99% effective at preventing maternal sensitization to Rh(D). To investigate global compliance with this therapeutic intervention, we used an epidemiological approach to estimate the current annual number of pregnancies worldwide involving an Rh(D)-negative mother and an Rh(D)-positive fetus. The annual number of doses of anti-Rh(D) IgG required for successful immunoprophylaxis for these cases was then calculated and compared with an estimate of the annual number of doses of anti-Rh(D) produced and provided worldwide. Our results suggest that ~50% of the women around the world who require this type of immunoprophylaxis do not receive it, presumably due to a lack of awareness, availability, and/or affordability, thereby putting hundreds of thousands of fetuses and neonates at risk for Rh disease each year. The global failure to provide this generally acknowledged standard-of-care to prevent Rh disease, even 50 years after its availability, contributes to an enormous, continuing burden of fetal and neonatal disease and provides a critically important challenge to the international health care system.
- Published
- 2020
- Full Text
- View/download PDF
4. Ultrasound markers for prediction of complex gastroschisis and adverse outcome
- Author
-
Gwendolyn T. R. Manten, Rene M. H. Wijnen, Chiara C. M. M. Lap, William L. M. Kramer, Titia E. Cohen-Overbeek, Eva Pajkrt, Caterina M. Bilardo, Dick Tibboel, Moska Aliasi, Lourens R. Pistorius, Eduard J. H. Mulder, Gerard H. A. Visser, Obstetrics and Gynaecology, APH - Personalized Medicine, APH - Quality of Care, Amsterdam Reproduction & Development (AR&D), Neonatology, Amsterdam Gastroenterology Endocrinology Metabolism, Obstetrics and gynaecology, Other Research, Pediatrics, Pediatric surgery, Obstetrics & Gynecology, Pediatric Surgery, RS: GROW - R4 - Reproductive and Perinatal Medicine, Obstetrie & Gynaecologie, and MUMC+: MA Medische Staf Obstetrie Gynaecologie (9)
- Subjects
Polyhydramnios ,NEONATAL SURVIVAL ,INFANTS ,0302 clinical medicine ,Pregnancy ,INTESTINAL ATRESIA ,Abdomen ,Medicine ,Longitudinal Studies ,Prospective Studies ,030219 obstetrics & reproductive medicine ,Radiological and Ultrasound Technology ,Obstetrics ,ultrasound ,gastroschisis ,Obstetrics and Gynecology ,General Medicine ,intra-abdominal bowel diameter ,Stillbirth ,Original Papers ,Volvulus ,PRENATAL ULTRASOUND ,ETIOLOGY ,Intestines ,Pulsatile Flow ,intra‐abdominal bowel diameter ,Gestation ,Female ,Cohort study ,medicine.medical_specialty ,Biometry ,mesenteric artery ,Perforation (oil well) ,Gestational Age ,DIAGNOSIS ,Risk Assessment ,Ultrasonography, Prenatal ,Healthcare improvement science Radboud Institute for Health Sciences [Radboudumc 18] ,bowel ,Diagnosis, Differential ,03 medical and health sciences ,DELIVERY ,Fetus ,Mesenteric Artery, Superior ,Predictive Value of Tests ,FETUSES ,030225 pediatrics ,Humans ,Radiology, Nuclear Medicine and imaging ,ARTERY DOPPLER VELOCIMETRY ,Fetal Death ,Original Paper ,business.industry ,Gastroschisis ,Other Research Radboud Institute for Health Sciences [Radboudumc 0] ,Infant, Newborn ,Retrospective cohort study ,medicine.disease ,Logistic Models ,Reproductive Medicine ,Relative risk ,Linear Models ,business ,Biomarkers - Abstract
Contains fulltext : 220734.pdf (Publisher’s version ) (Open Access) OBJECTIVES: To identify antenatal ultrasound markers that can differentiate between simple and complex gastroschisis and assess their predictive value. METHODS: This was a prospective nationwide study of pregnancies with isolated fetal gastroschisis that underwent serial longitudinal ultrasound examination at regular specified intervals between 20 and 37 weeks' gestation. The primary outcome was simple or complex (i.e. involving bowel atresia, volvulus, perforation or necrosis) gastroschisis at birth. Fetal biometry (abdominal circumference and estimated fetal weight), the occurrence of polyhydramnios, intra- and extra-abdominal bowel diameters and the pulsatility index (PI) of the superior mesenteric artery (SMA) were assessed. Linear mixed modeling was used to compare the individual trajectories of cases with simple and those with complex gastroschisis, and logistic regression analysis was used to estimate the strength of association between the ultrasound parameters and outcome. RESULTS: Of 104 pregnancies with isolated fetal gastroschisis included, four ended in intrauterine death. Eighty-one (81%) liveborn infants with simple and 19 (19%) with complex gastroschisis were included in the analysis. We found no relationship between fetal biometric variables and complex gastroschisis. The SMA-PI was significantly lower in fetuses with gastroschisis than in healthy controls, but did not differentiate between simple and complex gastroschisis. Both intra- and extra-abdominal bowel diameters were larger in cases with complex, compared to those with simple, gastroschisis (P < 0.001 and P < 0.005, respectively). The presence of intra-abdominal bowel diameter >/= 97.7(th) percentile on at least three occasions, not necessarily on successive examinations, was associated with an increased risk of the fetus having complex gastroschisis (relative risk, 1.56 (95% CI, 1.02-2.10); P = 0.006; positive predictive value, 50.0%; negative predictive value, 81.4%). CONCLUSIONS: This large prospective longitudinal study found that intra-abdominal bowel dilatation when present repeatedly during fetal development can differentiate between simple and complex gastroschisis; however, the positive predictive value is low, and therefore the clinical usefulness of this marker is limited. (c) 2019 Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
- Published
- 2020
5. A study of the healthcare resource use for the management of postpartum haemorrhage in France, Italy, the Netherlands, and the UK
- Author
-
Jessica Richardson, Kathryn Kelly, Tim Draycott, Gerard H. A. Visser, Cathy Winter, Thierry Harvey, Irene Cetin, Yum Lina Yip Sonderegger, Georgia Hollier-Hann, Julie Perroud, and Maria Chiara Alvisi
- Subjects
medicine.medical_specialty ,business.industry ,Obstetrics ,Postpartum Hemorrhage ,Psychological intervention ,Obstetrics and Gynecology ,Uterotonic ,medicine.disease ,United Kingdom ,Uterine atony ,Reproductive Medicine ,Obstetrics and gynaecology ,Pregnancy ,Oxytocics ,Health care ,medicine ,Resource use ,Humans ,Maternal death ,Female ,business ,Developed country ,Delivery of Health Care ,Netherlands - Abstract
Objective Postpartum haemorrhage (PPH) complicates approximately 5% of births worldwide and is a leading direct cause of maternal death. Rates of PPH are increasing in many developed countries, particularly PPH related to uterine atony. There is a lack of published up-to-date information about healthcare resource use associated with management of PPH following vaginal birth. The objective of this study was to describe healthcare resource use for the management of minor PPH (blood loss 500-1,000ml) and major PPH (blood loss >1,000ml) compared to uncomplicated birth (no PPH) following hospital vaginal birth in France, Italy, the Netherlands, and the UK. Study design In-depth interviews with two midwives from each participating country were conducted to establish differences in resource use for the management of minor PPH, major PPH, and uncomplicated birth. A web-survey was then developed and one obstetrician per participating country reviewed the survey. In total, 100 midwives (25 per country) completed the survey. Results were discussed at a multi-professional consensus meeting of midwives and obstetricians/gynaecologists (n=6). Results and Conclusions Midwives participating in the survey estimated that 80% of women receive Active Management of the Third Stage of Labour (AMTSL) and 93% of participants specified that uterotonics would routinely be used during AMTSL. Most participants (84%) reported that blood loss is routinely measured in their hospital, using a combination of methods. PPH is associated with increased healthcare resource use, including administration of additional uterotonics and use of additional medical interventions, such as urinary catheter, intravenous fluids, and possible requirement for surgery. The number of nurses, obstetricians/gynaecologists, and anaesthetists involved in the management of PPH increases with the occurrence and severity of PPH, as well as the proportion of healthcare personnel providing continuous care. Women may spend an additional 24 hours in hospital following major PPH compared to uncomplicated birth. The results of this study highlight the burden of PPH management on healthcare resources. To reduce costs associated with PPH, prevention is the most effective strategy and can be enhanced with the use of an effective uterotonic as part of the active management of the third stage of labour.
- Published
- 2021
6. Global surgery, obstetric, and anaesthesia indicator definitions and reporting: An Utstein consensus report
- Author
-
Justine Davies, Margit Steinholt, Geir Sverre Braut, Thomas G. Weiser, Kjetil Søreide, Gerard H. A. Visser, Carolina Haylock-Loor, John Varallo, John G. Meara, Walter D. Johnson, David A. K. Watters, Vatshalan Santhirapala, Julian Gore-Booth, Emmanuel A. Ameh, Mark W. Newton, Lars Hagander, Teri A. Reynolds, Lauri J. Romanzi, Michael S Lipnick, Jannicke Mellin-Olsen, Adrian W. Gelb, Kathryn M. Chu, Tore Laerdal, Christina Åkerman, Jose Miguel Guzman, Miliard Derbew, Hege Langli Ersdal, Emmanuel Makasa, Doris Østergaard, Bruce M Biccard, Andrew J M Leather, Emi Suzuki, Mark G. Shrime, David Ljungman, Sabrina Juran, Nicolas J. Kassebaum, Janet Martin, and Hampus Holmer
- Subjects
Epidemiology ,Economics ,Obstetric Surgical Procedures ,Social Sciences ,Commission ,Economic Geography ,Global Health ,Medical and Health Sciences ,Guidelines and Guidance ,Anesthesiology ,Global health ,Medicine and Health Sciences ,Anesthesia ,Public and Occupational Health ,Sociology ,Geography ,Pharmaceutics ,Financial risk ,Comparability ,Obstetrics and Gynecology ,General Medicine ,Obstetric Procedures ,Workforce ,Medicine ,Low and Middle Income Countries ,medicine.medical_specialty ,Consensus ,MEDLINE ,Surgical and Invasive Medical Procedures ,Basic Behavioral and Social Science ,Drug Therapy ,Clinical Research ,Medisinske Fag: 700 [VDP] ,General & Internal Medicine ,Behavioral and Social Science ,medicine ,Quality Indicators, Health Care ,business.industry ,allergology ,Prevention ,General surgery ,Perioperative ,Health indicator ,Surgery ,Health Care ,Good Health and Well Being ,Health Care Facilities ,Medical Risk Factors ,Quality Indicators ,Earth Sciences ,Women's Health ,Generic health relevance ,business - Abstract
Background Indicators to evaluate progress towards timely access to safe surgical, anaesthesia, and obstetric (SAO) care were proposed in 2015 by the Lancet Commission on Global Surgery. These aimed to capture access to surgery, surgical workforce, surgical volume, perioperative mortality rate, and catastrophic and impoverishing financial consequences of surgery. Despite being rapidly taken up by practitioners, data points from which to derive the indicators were not defined, limiting comparability across time or settings. We convened global experts to evaluate and explicitly define—for the first time—the indicators to improve comparability and support achievement of 2030 goals to improve access to safe affordable surgical and anaesthesia care globally. Methods and findings The Utstein process for developing and reporting guidelines through a consensus building process was followed. In-person discussions at a 2-day meeting were followed by an iterative process conducted by email and virtual group meetings until consensus was reached. The meeting was held between June 16 to 18, 2019; discussions continued until August 2020. Participants consisted of experts in surgery, anaesthesia, and obstetric care, data science, and health indicators from high-, middle-, and low-income countries. Considering each of the 6 indicators in turn, we refined overarching descriptions and agreed upon data points needed for construction of each indicator at current time (basic data points), and as each evolves over 2 to 5 (intermediate) and >5 year (full) time frames. We removed one of the original 6 indicators (one of 2 financial risk protection indicators was eliminated) and refined descriptions and defined data points required to construct the 5 remaining indicators: geospatial access, workforce, surgical volume, perioperative mortality, and catastrophic expenditure. A strength of the process was the number of people from global institutes and multilateral agencies involved in the collection and reporting of global health metrics; a limitation was the limited number of participants from low- or middle-income countries—who only made up 21% of the total attendees. Conclusions To track global progress towards timely access to quality SAO care, these indicators—at the basic level—should be implemented universally as soon as possible. Intermediate and full indicator sets should be achieved by all countries over time. Meanwhile, these evolutions can assist in the short term in developing national surgical plans and collecting more detailed data for research studies., Justine Davies and colleagues discuss the development of updated indicators to support global achievement of access to safe surgical, anaesthetic, and obstetric care.
- Published
- 2021
7. A literature review and best practice advice for second and third trimester risk stratification, monitoring, and management of pre-eclampsia: Compiled by the Pregnancy and Non-Communicable Diseases Committee of FIGO (the International Federation of Gynecology and Obstetrics)
- Author
-
Anil Kapur, Vincenzo Berghella, Roberto Romero, Huixia Yang, Nir Melamed, Eyal Sheiner, Moshe Hod, K. H. Nicolaides, Peter von Dadelszen, Gerard H. A. Visser, A.B. Kihara, Stefan Verlohren, Amala Nazareth, Liona C. Poon, Hema Divakar, Eran Hadar, Muna Tahlak, H. David McIntyre, Fionnuala M. McAuliffe, Fabrício da Silva Costa, Laura A. Magee, and Andrew Shennan
- Subjects
medicine.medical_specialty ,Best practice ,Pregnancy Trimester, Third ,Third trimester ,Risk Assessment ,Ultrasonography, Prenatal ,Pre-Eclampsia ,Second trimester ,Predictive Value of Tests ,Pregnancy ,medicine ,Humans ,Noncommunicable Diseases ,Eclampsia ,Obstetrics ,business.industry ,Obstetrics and Gynecology ,General Medicine ,medicine.disease ,Pregnancy Trimester, First ,Uterine Artery ,Pregnancy Trimester, Second ,Risk stratification ,Female ,Ultrasonography ,business ,Risk assessment ,Biomarkers - Published
- 2021
8. Using three‐dimensional ultrasound in predicting complex gastroschisis: A longitudinal, prospective, multicenter cohort study
- Author
-
Chiara C. M. M. Lap, William L. M. Kramer, Dick Tibboel, Rene M. H. Wijnen, Gwendolyn T. R. Manten, Titia E. Cohen-Overbeek, Hens A. A. Brouwers, Anton H. van Kaam, Robertine van Baren, Caterina M. Bilardo, Eva Pajkrt, Moska Aliasi, Annelieke Hijkoop, Lourens R. Pistorius, Eduard J. H. Mulder, Gerard H. A. Visser, Pediatric Surgery, Obstetrics & Gynecology, Reproductive Origins of Adult Health and Disease (ROAHD), ARD - Amsterdam Reproduction and Development, Obstetrics and Gynaecology, APH - Personalized Medicine, APH - Quality of Care, and Neonatology
- Subjects
Adult ,Perforation (oil well) ,DIAGNOSIS ,Ultrasonography, Prenatal ,Young Adult ,Imaging, Three-Dimensional ,Pregnancy ,medicine ,Humans ,3D ultrasound ,Longitudinal Studies ,Prospective Studies ,Prospective cohort study ,Genetics (clinical) ,Gastroschisis ,medicine.diagnostic_test ,business.industry ,Stomach ,digestive, oral, and skin physiology ,Intestinal atresia ,Ultrasound ,Obstetrics and Gynecology ,Gestational age ,Original Articles ,medicine.disease ,medicine.anatomical_structure ,Original Article ,Female ,Nuclear medicine ,business - Abstract
Objective To determine whether complex gastroschisis (ie, intestinal atresia, perforation, necrosis, or volvulus) can prenatally be distinguished from simple gastroschisis by fetal stomach volume and stomach‐bladder distance, using three‐dimensional (3D) ultrasound. Methods This multicenter prospective cohort study was conducted in the Netherlands between 2010 and 2015. Of seven university medical centers, we included the four centers that performed longitudinal 3D ultrasound measurements at a regular basis. We calculated stomach volumes (n = 223) using Sonography‐based Automated Volume Count. The shortest stomach‐bladder distance (n = 241) was determined using multiplanar visualization of the volume datasets. We used linear mixed modelling to evaluate the effect of gestational age and type of gastroschisis (simple or complex) on fetal stomach volume and stomach‐bladder distance. Results We included 79 affected fetuses. Sixty‐six (84%) had been assessed with 3D ultrasound at least once; 64 of these 66 were liveborn, nine (14%) had complex gastroschisis. With advancing gestational age, stomach volume significantly increased, and stomach‐bladder distance decreased (both P, What's already known about this topic? Infants with complex gastroschisis have a higher risk of morbidity than those with simple gastroschisis.Many attempts have been made to prenatally predict complex gastroschisis, using two‐dimensional ultrasound parameters. What does this study add? This longitudinal prospective multicenter study is the first to evaluate the possible benefit of the use of three‐dimensional ultrasound in fetuses with gastroschisis.Fetal stomach volume and stomach‐bladder distance, measured during pregnancy using three‐dimensional ultrasound, cannot predict complex gastroschisis.
- Published
- 2019
9. Antenatal glucocorticoid treatment affects hippocampal development in mice.
- Author
-
Cornelle W Noorlander, Deodata Tijsseling, Ellen V S Hessel, Willem B de Vries, Jan B Derks, Gerard H A Visser, and Pierre N E de Graan
- Subjects
Medicine ,Science - Abstract
Synthetic glucocorticoids are administered to pregnant women at risk for preterm delivery, to enhance fetal lung maturation. The benefit of this treatment is well established, however caution is necessary because of possible unwanted side effects on development of different organ systems, including the brain. Actions of glucocorticoids are mediated by corticosteroid receptors, which are highly expressed in the hippocampus, a brain structure involved in cognitive functions. Therefore, we analyzed the effects of a single antenatal dexamethasone treatment on the development of the mouse hippocampus. A clinically relevant dose of dexamethasone (0.4 mg/kg) was administered to pregnant mice at embryonic day 15.5 and the hippocampus was analyzed from embryonic day 16 until adulthood. We investigated the effects of dexamethasone treatment on anatomical changes, apoptosis and proliferation in the hippocampus, hippocampal volume and on total body weight. Our results show that dexamethasone treatment reduced body weight and hippocampal volume transiently during development, but these effects were no longer detected at adulthood. Dexamethasone treatment increased the number of apoptotic cells in the hippocampus until birth, but postnatally no effects of dexamethasone treatment on apoptosis were found. During the phase with increased apoptosis, dexamethasone treatment reduced the number of proliferating cells in the subgranular zone of the dentate gyrus. The number of proliferative cells was increased at postnatal day 5 and 10, but was decreased again at the adult stage. This latter long-term and negative effect of antenatal dexamethasone treatment on the number of proliferative cells in the hippocampus may have important implications for hippocampal network function.
- Published
- 2014
- Full Text
- View/download PDF
10. Offspring of mothers with hyperglycaemia in pregnancy: The short term and long-term impact. What is new?
- Author
-
Umberto Simeoni, Ronald C.W. Ma, Gerard H. A. Visser, Jean-Baptiste Armengaud, and Benazir Siddeek
- Subjects
Offspring ,Endocrinology, Diabetes and Metabolism ,Mothers ,030209 endocrinology & metabolism ,Overweight ,Infant, Newborn, Diseases ,03 medical and health sciences ,0302 clinical medicine ,Endocrinology ,Pregnancy ,Diabetes mellitus ,Internal Medicine ,Global health ,Humans ,Medicine ,030212 general & internal medicine ,Early childhood ,business.industry ,Infant, Newborn ,Pregnancy Outcome ,General Medicine ,medicine.disease ,Obesity ,Pregnancy Complications ,Gestational diabetes ,Diabetes, Gestational ,Hyperglycemia ,Female ,medicine.symptom ,business ,Demography - Abstract
The continuing rise in the global prevalence of diabetes and overweight or obesity has become a major burden for global health, as the pandemic is affecting both high and low-middle income countries (LMIC). At the same time, a similar pattern has been observed for all forms of hyperglycemia in pregnancy (HIP), diabetes during pregnancy and gestational diabetes. The offspring of mothers with HIP and/or overweight-obesity is receiving increasing attention as advances in early detection and treatment of HIP did not completely prevent macrosomia and its associated short-term perinatal disorders, whilst long term consequences are observed in the mother and in offspring as it reaches adulthood. This review discusses the current developments in the consequences of HIP in the offspring, with a particular focus on its long-term health at adulthood, and on intergenerational and transgenerational effects. HIP is emerging as one of the factors that can contribute, during the window of sensitivity to environmental cues constituted by the preconception, pregnancy, and early childhood, and as an amplifying factor linked to reproduction, to the current global epidemic of diabetes and non-communicable diseases (NCDs).
- Published
- 2018
11. A framework for safe obstetrical practices
- Author
-
Gerard H. A. Visser and Anwar H. Nassar
- Subjects
Nursing ,business.industry ,Obstetrics and Gynecology ,Medicine ,General Medicine ,business - Published
- 2021
12. FIGO position paper on reference charts for fetal growth and size at birth: Which one to use?
- Author
-
Eytan R. Barnea, Gerard H. A. Visser, Anwar H. Nassar, Diana Ramasauskaite, and Wanda K. Nicholson
- Subjects
medicine.medical_specialty ,Percentile ,Growth data ,Gestational Age ,Fetal Development ,03 medical and health sciences ,0302 clinical medicine ,Chart ,Pregnancy ,medicine ,Fetal growth ,Birth Weight ,Humans ,030212 general & internal medicine ,Growth Charts ,030219 obstetrics & reproductive medicine ,Obstetrics ,business.industry ,Infant, Newborn ,Obstetrics and Gynecology ,Reproducibility of Results ,General Medicine ,Predictive value ,Clinical Practice ,Infant, Small for Gestational Age ,Position paper ,Female ,business - Abstract
Publication of the Intergrowth-21st and WHO growth charts raises the question of which growth data prenatal providers should use in clinical practice. Is it better to use a universal chart applied globally, or metrics based on local or regional growth patterns? And what about customized charts versus local charts? FIGO has reviewed the different growth charts and studies assessing their reproducibility and predictive values for small- and large-for-gestational age newborns and, where available, adverse fetal outcomes. It concludes that local or regional charts are likely to be best for identifying the 10th percentile of newborns at highest risk. However, international standards for growth may also be used when coupled with locally appropriate thresholds for risk interpretation.
- Published
- 2020
13. Don't forget eclampsia in the efforts to reduce maternal morbidity and mortality
- Author
-
Wanda K. Nicholson, Obstetrics Safe Motherhood, William Stones, Eytan R. Barnea, Gerard H. A. Visser, and Anwar H. Nassar
- Subjects
medicine.medical_specialty ,Maternal morbidity ,Disease ,03 medical and health sciences ,0302 clinical medicine ,Pre-Eclampsia ,Pregnancy ,Health care ,Medicine ,Humans ,Eclampsia ,030212 general & internal medicine ,Intensive care medicine ,reproductive and urinary physiology ,Health policy ,030219 obstetrics & reproductive medicine ,business.industry ,Obstetrics and Gynecology ,Postpartum care ,General Medicine ,Hypertension, Pregnancy-Induced ,medicine.disease ,Maternal Mortality ,Workforce ,Female ,business - Abstract
Hypertensive disorders are a leading cause of maternal morbidity and mortality worldwide. Despite advances in prevention and clinical management, women in low-resource countries continue to bear the burden of the sequelae of severe pre-eclampsia-eclampsia. Sustainable strategies to improve the care of women with hypertensive disease, to identify those at risk for hypertensive disease, and to reduce the risk of eclampsia will require partnerships between clinicians and health policy makers. Resources are needed to scale up healthcare access and infrastructure, establish evidence-based protocols for care, and ensure an adequate supply of equipment and drugs. Additionally, efforts for a sustained workforce of perinatal clinicians and staff trained in the assessment and management of hypertensive disease are needed. Effective postpartum care and monitoring are essential to prevent morbidity and mortality due to cardiovascular disease. Culturally appropriate strategies are needed to educate women and their families on the symptoms of pre-eclampsia to address delays in seeking care during pregnancy and postpartum. With targeted, sustained efforts and resources, eclampsia and its associated co-morbidities can be preventable.
- Published
- 2020
14. FIGO/ICM guidelines for preventing Rhesus disease: A call to action
- Author
-
Gerard H A, Visser, Trude, Thommesen, Gian Carlo, Di Renzo, Anwar H, Nassar, Steven L, Spitalnik, and Alison, Wright
- Subjects
medicine.medical_specialty ,Rho(D) Immune Globulin ,FIGO ,Disease ,Guidelines ,Rh Isoimmunization ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,International Confederation of Midwives ,medicine ,Humans ,030212 general & internal medicine ,Intensive care medicine ,030219 obstetrics & reproductive medicine ,Disease Eradication ,business.industry ,Prophylaxis ,Obstetrics and Gynecology ,General Medicine ,Call to action ,Obstetrics ,Worldwide Initiative for Rhesus Disease Eradication ,Female ,Rhesus disease ,Figo Guideline ,business ,Anti‐D immunoglobulin - Abstract
The introduction of anti‐Rh(D) immunoglobulin more than 50 years ago has resulted in only a 50% decrease in Rhesus disease globally owing to a low uptake of this prophylactic approach. The International Federation of Gynecology and Obstetrics, International Confederation of Midwives, and Worldwide Initiative for Rhesus Disease Eradication have reviewed current evidence regarding the utility of anti‐Rh(D) immunoglobulin. Taking into account the effectiveness anti‐Rh(D), the new guidelines propose adjusting the dose for different indications and prioritizing its administration by indication., These FIGO/ICM guidelines review the evidence regarding the usefulness of anti‐Rh(D) immunoglobulin, prioritizing its administration by indication.
- Published
- 2020
15. FIGO Statement: Vaccination in pregnancy
- Author
-
Anwar H, Nassar, Gerard H A, Visser, Wanda Kay, Nicholson, Diana, Ramasauskaite, Yoon Ha, Kim, Eytan R, Barnea, and Alison, Wright
- Subjects
Adult ,medicine.medical_specialty ,Safe motherhood ,Diphtheria-Tetanus-acellular Pertussis Vaccines ,complex mixtures ,Vulnerable Populations ,Group B ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,Risk Factors ,medicine ,Humans ,030212 general & internal medicine ,Vaccines ,030219 obstetrics & reproductive medicine ,Obstetrics ,Tetanus ,business.industry ,Vaccination ,Toxoid ,Infant, Newborn ,Obstetrics and Gynecology ,Streptococcus infection ,General Medicine ,medicine.disease ,Influenza Vaccines ,Female ,business ,Acellular pertussis - Abstract
Pregnant women and their fetuses are among the vulnerable populations that can be severely affected by communicable diseases. As such, some vaccines such as the influenza and the Tdap (tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis) vaccines are strongly recommended in each pregnancy, with generally safe profiles. Other vaccines can be offered based on risk factors, and only when the benefits of receiving them outweigh the risks. Development of vaccines against group B streptococcus infection and respiratory syncytial virus infection are of great importance. In this paper, the recommendations for administration of each vaccine during pregnancy are discussed. The FIGO Committee for Safe Motherhood and Newborn Health Committee endorses the recommendations to vaccinate all pregnant women against influenza during the influenza season at any time during the pregnancy and against Tdap preferably between the 27th and 36th weeks of pregnancy in each pregnancy.
- Published
- 2020
16. Antenatal maternal antidepressants drugs treatment affects S100B levels in maternal-fetal biological fluids in a dose dependent manner
- Author
-
Valentina Bellissima, Gerard H. A. Visser, Francesco Nigro, Francesca Romana Pluchinotta, Danilo Gavilanes, Justyna Godos, Alessandro Varrica, Lucia Gabriella Tina, Diego Gazzolo, Ekaterina Baryshnikova, Tessa Ververs, RS: MHeNs - R3 - Neuroscience, Kindergeneeskunde, and MUMC+: MA Medische Staf Kindergeneeskunde (9)
- Subjects
0301 basic medicine ,Amniotic fluid ,s100b ,Clinical Biochemistry ,Dose dependence ,PROTEIN ,AMNIOTIC-FLUID ,Biochemistry ,SUPPLEMENTATION ,circumference ,0302 clinical medicine ,Central Nervous System Diseases ,newborn ,Pregnancy ,Medicine ,SSRI ,CORD BLOOD ,GESTATIONAL-AGE ,Depression (differential diagnoses) ,Obstetrics ,General Medicine ,DEPRESSION ,Paroxetine ,Antidepressive Agents ,030220 oncology & carcinogenesis ,Maternal-Fetal Relations ,Antidepressant ,Female ,medicine.drug ,Adult ,medicine.medical_specialty ,brain ,S100 Calcium Binding Protein beta Subunit ,serotonin-reuptake inhibitors ,03 medical and health sciences ,Fetus ,BLOOD S100B ,Biological fluids ,Humans ,Dose-Response Relationship, Drug ,Clinical Laboratory Techniques ,business.industry ,Biochemistry (medical) ,Amniotic Fluid ,medicine.disease ,Cross-Sectional Studies ,030104 developmental biology ,business ,Biomarkers - Abstract
Background The increased use of antidepressant treatment during pregnancy occurred without firm evidence on safety/efficacy. The present study investigated the correlation among S100B and paroxetine blood levels with the occurrence of short-term post-natal neurological abnormalities. Methods We conducted a cross-sectional study in 50 pregnant women using paroxetine because of depression and in 150 controls. Standard laboratory parameters and S100B were measured at seven monitoring time-points (maternal blood: T1, 16–20 wks; T2, 27–30 wks; T3, 35–40 wks; T4, at delivery; amniotic fluid, T5; venous and arterial cord blood, T6-T7). Paroxetine levels were measured at T1-T6. Neurological outcome was set at 7th day from birth. Results Higher S100B concentrations at T1-T7 were found in the paroxetine-treated group. S100B correlated with paroxetine blood levels. The paroxetine/S100B ratio cut-off of 1.31 at T2 achieved sensitivity 100%, specificity 96.5% and positive/negative predictive values 87.5–100, respectively, as a single marker to predict adverse neonatal neurological outcome. Conclusions The present study offers additional support to the usefulness of longitudinal S100B and drug level monitoring in depressed pregnant women and in the early detection of cases at risk for short-term neurological abnormalities. Results open the way at further investigations correlating antidepressant drugs and neurobiomarkers in the maternal bloodstream.
- Published
- 2020
17. Hemolytic disease of the fetus and newborn due to Rh(D) incompatibility: A preventable disease that still produces significant morbidity and mortality in children
- Author
-
Alvin Zipursky, Valeria Pegoraro, Gerard H. A. Visser, Ducciocompet Urbinati, Gian Carlo Di Renzo, Brie A. Stotler, and Steven L. Spitalnik
- Subjects
Rho(D) Immune Globulin ,Maternal Health ,Disease ,030204 cardiovascular system & hematology ,Global Health ,Blood group antigens ,Geographical Locations ,Labor and Delivery ,0302 clinical medicine ,Pregnancy ,Epidemiology ,Medicine and Health Sciences ,Global health ,Public and Occupational Health ,Sensitization ,Rh-Hr Blood-Group System ,030219 obstetrics & reproductive medicine ,Multidisciplinary ,Obstetrics ,Obstetrics and Gynecology ,Europe ,Neonatal morbidity ,medicine.anatomical_structure ,Medicine ,Female ,Immunotherapy ,Research Article ,medicine.medical_specialty ,Asia ,Science ,Rh Isoimmunization ,Erythroblastosis, Fetal ,03 medical and health sciences ,medicine ,Humans ,Caribbean ,Fetus ,business.industry ,Infant, Newborn ,Biology and Life Sciences ,Neonates ,medicine.disease ,People and Places ,North America ,Africa ,Birth ,Women's Health ,business ,Developmental Biology - Abstract
In the mid-20th century, Hemolytic Disease of the Fetus and Newborn, caused by maternal alloimmunization to the Rh(D) blood group antigen expressed by fetal red blood cells (i.e., “Rh disease”), was a major cause of fetal and neonatal morbidity and mortality. However, with the regulatory approval, in 1968, of IgG anti-Rh(D) immunoprophylaxis to prevent maternal sensitization, the prospect of eradicating Rh disease was at hand. Indeed, the combination of antenatal and post-partum immunoprophylaxis is ~99% effective at preventing maternal sensitization to Rh(D). To investigate global compliance with this therapeutic intervention, we used an epidemiological approach to estimate the current annual number of pregnancies worldwide involving an Rh(D)-negative mother and an Rh(D)-positive fetus. The annual number of doses of anti-Rh(D) IgG required for successful immunoprophylaxis for these cases was then calculated and compared with an estimate of the annual number of doses of anti-Rh(D) produced and provided worldwide. Our results suggest that ~50% of the women around the world who require this type of immunoprophylaxis do not receive it, presumably due to a lack of awareness, availability, and/or affordability, thereby putting hundreds of thousands of fetuses and neonates at risk for Rh disease each year. The global failure to provide this generally acknowledged standard-of-care to prevent Rh disease, even 50 years after its availability, contributes to an enormous, continuing burden of fetal and neonatal disease and provides a critically important challenge to the international health care system.
- Published
- 2020
18. Short-term and long-term effects of caesarean section on the health of women and children
- Author
-
Glen Mola, Rachel M. Tribe, Hussein Kidanto, Paul D. Taylor, Marleen Temmerman, Lisa Avery, Niamh M. Kelly, Deena L. Gibbons, Caroline S.E. Homer, Holly Powell Kennedy, Jane Sandall, and Gerard H. A. Visser
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,Global Health ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,Risk Factors ,Global health ,Humans ,Medicine ,Caesarean section ,030212 general & internal medicine ,Microbiome ,Poverty ,Asthma ,030219 obstetrics & reproductive medicine ,Cesarean Section ,business.industry ,Obstetrics ,Incidence (epidemiology) ,Infant, Newborn ,Pregnancy Outcome ,General Medicine ,medicine.disease ,Obesity ,Uterine rupture ,Female ,business - Abstract
Summary A caesarean section (CS) can be a life-saving intervention when medically indicated, but this procedure can also lead to short-term and long-term health effects for women and children. Given the increasing use of CS, particularly without medical indication, an increased understanding of its health effects on women and children has become crucial, which we discuss in this Series paper. The prevalence of maternal mortality and maternal morbidity is higher after CS than after vaginal birth. CS is associated with an increased risk of uterine rupture, abnormal placentation, ectopic pregnancy, stillbirth, and preterm birth, and these risks increase in a dose–response manner. There is emerging evidence that babies born by CS have different hormonal, physical, bacterial, and medical exposures, and that these exposures can subtly alter neonatal physiology. Short-term risks of CS include altered immune development, an increased likelihood of allergy, atopy, and asthma, and reduced intestinal gut microbiome diversity. The persistence of these risks into later life is less well investigated, although an association between CS use and greater incidence of late childhood obesity and asthma are frequently reported. There are few studies that focus on the effects of CS on cognitive and educational outcomes. Understanding potential mechanisms that link CS with childhood outcomes, such as the role of the developing neonatal microbiome, has potential to inform novel strategies and research for optimising CS use and promote optimal physiological processes and development.
- Published
- 2018
19. European Consensus Guidelines on the Management of Respiratory Distress Syndrome-2019 Update
- Author
-
Eren Özek, Richard Plavka, Ola Didrik Saugstad, Gorm Greisen, Arjan B. te Pas, Christian P. Speer, Gerard H. A. Visser, Virgilio P. Carnielli, Máximo Vento, David G. Sweet, Mikko Hallman, Henry L. Halliday, Charles Christoph Roehr, Umberto Simeoni, Sweet, David G., Carnielli, Virgilio, Greisen, Gorm, Hallman, Mikko, Ozek, Eren, te Pas, Arjan, Plavka, Richard, Roehr, Charles C., Saugstad, Ola D., Simeoni, Umberto, Speer, Christian P., Vento, Maximo, Visser, Gerhard H. A., and Halliday, Henry L.
- Subjects
LARYNGEAL MASK AIRWAY ,Hyaline membrane disease ,medicine.medical_treatment ,Patent ductus arteriosus ,Antenatal steroids ,0302 clinical medicine ,Mechanical ventilation ,Neonatologists ,Obstetrics and gynaecology ,030212 general & internal medicine ,Continuous positive airway pressure ,PREMATURE-INFANTS ,Respiratory distress ,Disease Management ,Consensus Guidelines ,Evidence-based practice ,Europe ,Distress ,Preterm infant ,PATENT DUCTUS-ARTERIOSUS ,Infant, Premature ,BIRTH-WEIGHT INFANTS ,medicine.medical_specialty ,Consensus ,Respiratory distress syndrome ,POSITIVE AIRWAY PRESSURE ,OXYGEN-SATURATION TARGETS ,Lung injury ,HIGH-FLOW THERAPY ,Surfactant therapy ,Thermoregulation ,03 medical and health sciences ,030225 pediatrics ,medicine ,Humans ,Intensive care medicine ,Nutrition ,Respiratory Distress Syndrome, Newborn ,EXTREMELY PRETERM INFANTS ,business.industry ,Infant, Newborn ,Infant ,Pulmonary Surfactants ,BRONCHOPULMONARY DYSPLASIA ,RANDOMIZED-TRIAL ,Oxygen supplementation ,Pediatrics, Perinatology and Child Health ,business ,Developmental Biology - Abstract
As management of respiratory distress syndrome (RDS) advances, clinicians must continually revise their current practice. We report the fourth update of "European Guidelines for the Management of RDS" by a European panel of experienced neonatologists and an expert perinatal obstetrician based on available literature up to the end of 2018. Optimising outcome for babies with RDS includes prediction of risk of preterm delivery, need for appropriate maternal transfer to a perinatal centre and timely use of antenatal steroids. Delivery room management has become more evidence-based, and protocols for lung protection including initiation of CPAP and titration of oxygen should be implemented immediately after birth. Surfactant replacement therapy is a crucial part of management of RDS, and newer protocols for its use recommend early administration and avoidance of mechanical ventilation. Methods of maintaining babies on non-invasive respiratory support have been further developed and may cause less distress and reduce chronic lung disease. As technology for delivering mechanical ventilation improves, the risk of causing lung injury should decrease, although minimising time spent on mechanical ventilation using caffeine and, if necessary, postnatal steroids are also important considerations. Protocols for optimising general care of infants with RDS are also essential with good temperature control, careful fluid and nutritional management, maintenance of perfusion and judicious use of antibiotics all being important determinants of best outcome. (c) 2019 S. Karger AG, Basel
- Published
- 2019
20. Retrospective study of the effect of remifentanil use during labor on fetal heart rate patterns
- Author
-
Gerard H. A. Visser, Jan G. Nijhuis, Martine M. L. H. Wassen, Danne Boterenbrood, RS: GROW - R4 - Reproductive and Perinatal Medicine, Obstetrie & Gynaecologie, and MUMC+: MA Obstetrie Gynaecologie (3)
- Subjects
Adult ,Anemia ,Remifentanil ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Piperidines ,Pregnancy ,medicine.artery ,Heart rate ,Humans ,Hypnotics and Sedatives ,Medicine ,Clinical significance ,030212 general & internal medicine ,ANEMIA ,CLINICAL-SIGNIFICANCE ,Netherlands ,Retrospective Studies ,Fetus ,Labor, Obstetric ,030219 obstetrics & reproductive medicine ,business.industry ,Infant, Newborn ,Obstetrics and Gynecology ,Retrospective cohort study ,Umbilical artery ,General Medicine ,Heart Rate, Fetal ,Neonatal outcome ,medicine.disease ,Fetal heart rate ,Anesthesia ,Sinusoidal heart rate pattern ,Female ,business ,SIGN ,medicine.drug - Abstract
ObjectiveTo investigate possible associations between remifentanil and the appearance of sinusoidal heart rate patterns in fetuses, and neonatal outcomes. MethodsThe present retrospective cohort study included data from patients at over 37weeks of singleton or multiple pregnancies attending Zuyderland Medical Center, Sittard, the Netherlands, in labor between June 1, and August 31, 2015. Patient data were stratified by whether remifentanil was administered during delivery (remifentanil group) or not (control group), and fetal heart rate tracings were reviewed to identify sinusoidal heart rate patterns. The neonatal outcomes compared were 5-minute Apgar scores and umbilical artery pH. ResultsThere were 119 patients included in the study; 60 in the remifentanil group and 59 in the control group. Tracings from 20 (33%) patients in the remifentanil group exhibited a sinusoidal heart rate pattern after remifentanil administration, compared with 5 (8%) patients in the control group (P=0.001). The median time before the onset of sinusoidal patterns after remifentanil administration was 12minutes. No adverse neonatal outcomes were recorded in either group. ConclusionRemifentanil use during labor was associated with the occurrence of sinusoidal heart rate patterns in the fetus; this was not associated with adverse neonatal outcomes. Remifentanil use during labor was associated with sinusoidal heart rate patterns in fetuses but not adverse neonatal outcomes.
- Published
- 2018
21. The association between intrauterine inflammation and spontaneous vaginal delivery at term: a cross-sectional study.
- Author
-
Michiel L Houben, Peter G J Nikkels, Grada M van Bleek, Gerard H A Visser, Maroeska M Rovers, Hilda Kessel, Wouter J de Waal, Leontine Schuijff, Annemiek Evers, Jan L L Kimpen, and Louis Bont
- Subjects
Medicine ,Science - Abstract
BACKGROUND:Different factors contribute to the onset of labor at term. In animal models onset of labor is characterized by an inflammatory response. The role of intrauterine inflammation, although implicated in preterm birth, is not yet established in human term labor. We hypothesized that intrauterine inflammation at term is associated with spontaneous onset of labor. METHODS/RESULTS:In two large urban hospitals in the Netherlands, a cross-sectional study of spontaneous onset term vaginal deliveries and elective caesarean sections (CS), without signs of labor, was carried out. Placentas and amniotic fluid samples were collected during labor and/or at delivery. Histological signs of placenta inflammation were determined. Amniotic fluid proinflammatory cytokine concentrations were measured using ELISA. A total of 375 women were included. In term vaginal deliveries, more signs of intrauterine inflammation were found than in elective CS: the prevalence of chorioamnionitis was higher (18 vs 4%, p = 0.02) and amniotic fluid concentration of IL-6 was higher (3.1 vs 0.37 ng/mL, p
- Published
- 2009
- Full Text
- View/download PDF
22. How to monitor pregnancies complicated by fetal growth restriction and delivery before 32 weeks: post-hoc analysis of TRUFFLE study
- Author
-
A Valcamonico, Ktm Schneider, Enrico Ferrazzi, A. G. van Wassenaer-Leemhuis, N. Mensing van Charante, Christoph Lees, Wessel Ganzevoort, Caterina M. Bilardo, Aris T. Papageorghiou, Anke Diemert, Gerard H. A. Visser, Kurt Hecher, Pasquale Martinelli, Federico Prefumo, Birgit Arabin, J.J. Duvekot, Neil Marlow, Tullia Todros, E. Ostermayer, Hans Wolf, J. B. Derks, Christoph Brezinka, Dietmar Schlembach, Tiziana Frusca, and Baskaran Thilaganathan
- Subjects
Pediatrics ,medicine.medical_specialty ,Pregnancy ,Fetus ,030219 obstetrics & reproductive medicine ,Radiological and Ultrasound Technology ,medicine.diagnostic_test ,business.industry ,Obstetrics and Gynecology ,Intrauterine growth restriction ,Gestational age ,General Medicine ,Placental insufficiency ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,Reproductive Medicine ,medicine ,Radiology, Nuclear Medicine and imaging ,Cardiotocography ,030212 general & internal medicine ,business ,Survival analysis ,Ductus venosus - Abstract
OBJECTIVES: In the recent TRUFFLE study it appeared that, in pregnancies complicated by fetal growth restriction (FGR) between 26 and 32 weeks, monitoring of the ductus venosus (DV) combined with computerised cardiotocography (cCTG) as a trigger for delivery, increased the chance of infant survival without neurological impairment. However, concerns in interpretation were raised as DV monitoring appeared associated with a non-significant increase in fetal death, and part of the infants were delivered after 32 weeks, after which the study protocol was no longer applied. This secondary sensitivity analysis focuses on women who delivered before 32 completed weeks, and analyses fetal death cases in detail. METHODS: We analysed the monitoring data of 317 women who delivered before 32 weeks, excluding women with absent infant outcome data or inevitable perinatal death. The association of the last monitoring data before delivery and infant outcome was assessed by multivariable analysis. RESULTS: The primary outcome (two year survival without neurological impairment) occurred more often in the two DV groups (both 83%) than in the CTG-STV group (77%), however the difference was not statistically significant (p = 0.21). Nevertheless, in surviving infants 93% was free of neurological impairment in the DV groups versus 85% in the CTG-STV group (p = 0.049). All fetal deaths (n = 7) occurred in women allocated to DV monitoring, which explains this difference. Assessment of the monitoring parameters that were obtained shortly before fetal death in these 7 cases showed an abnormal CTG in only one. Multivariable regression analysis of factors at study entry demonstrated that higher gestational age, larger estimated fetal weight 50th percentile ratio and lower U/C ratio were significantly associated with the (normal) primary outcome. Allocation to the DV groups had a smaller effect, but remained in the model (p
- Published
- 2017
23. Trial of vaginal breech delivery in carefully selected women is worth considering—Fruit for thought!
- Author
-
Gerard H. A. Visser
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,03 medical and health sciences ,Breech delivery ,0302 clinical medicine ,Pregnancy ,Optimal route ,medicine ,Humans ,Caesarean section ,030212 general & internal medicine ,Breech Presentation ,reproductive and urinary physiology ,030219 obstetrics & reproductive medicine ,Cesarean Section ,business.industry ,Obstetrics ,Obstetrics and Gynecology ,Delivery, Obstetric ,female genital diseases and pregnancy complications ,Mode of delivery ,Reproductive Medicine ,Neonatal outcomes ,Fruit ,Female ,Elective caesarean section ,business - Abstract
There remains uncertainty about the optimal route of delivering carefully selected breech babies at term. This review argues strongly that vaginal mode of delivery should be considered in selected cases rather than offering an elective caesarean section for every patient.
- Published
- 2020
24. Significant reduction in umbilical artery metabolic acidosis after implementation of intrapartum ST waveform analysis of the fetal electrocardiogram
- Author
-
Maria P.H. Koster, Anadeijda J E M C Landman, Saskia T Immink-Duijker, Serena Xodo, Floris Groenendaal, Anneke Kwee, Eduard J. H. Mulder, Gerard H. A. Visser, and Obstetrics & Gynecology
- Subjects
medicine.medical_specialty ,ST waveform analysis ,real-world observation ,fetal heart rate monitoring ,Umbilical cord ,03 medical and health sciences ,0302 clinical medicine ,intrapartum fetal surveillance ,medicine.artery ,Obstetrics and Gynaecology ,medicine ,Journal Article ,Cardiotocography ,030212 general & internal medicine ,perinatal asphyxia ,observational studies ,030219 obstetrics & reproductive medicine ,medicine.diagnostic_test ,umbilical artery metabolic acidosis ,business.industry ,Neonatal encephalopathy ,Obstetrics ,fetal electrocardiogram ,Obstetrics and Gynecology ,Gestational age ,ST Waveform Analysis ,Metabolic acidosis ,Umbilical artery ,CTG ,medicine.disease ,fetal blood sampling ,Perinatal asphyxia ,monitoring ,fetus ,medicine.anatomical_structure ,learning curve ,business - Abstract
Background: Although the evidence regarding the benefit of using ST waveform analysis of the fetal electrocardiogram is conflicting, ST waveform analysis is considered as adjunct to identify fetuses at risk for asphyxia in our center. Most randomized controlled trials and meta-analyses have not shown a significant decrease in umbilical metabolic acidosis, while some observational studies have shown a gradual decrease of this outcome over a longer period of time. Observational studies can give more insight into the effect of implementation of the ST technology in daily clinical practice. Objective: To evaluate the change in frequency of perinatal intervention and adverse neonatal outcome after the implementation of ST waveform analysis of the fetal electrocardiogram from 2000 to 2013. Study Design: This retrospective longitudinal study was conducted in a tertiary referral center. A total of 19,664 medium- and high-risk singleton pregnancies with fetuses in cephalic presentation, a gestational age of ≥36 weeks, and the intention to deliver vaginally were included. ST waveform analysis of the fetal electrocardiogram was implemented in the year 2000 and by 2010 all deliveries were monitored using this technology. Data were collected on the following perinatal outcomes: fetal blood sampling, mode of delivery, umbilical cord blood gases, Apgar scores, neonatal encephalopathy, and perinatal death. Longitudinal trend analysis was used to detect changes over time in all deliveries monitored by cardiotocography either alone or in adjunct to ST waveform analysis of the fetal electrocardiogram. Logistic regression was used to correct for possible confounders. Results: The umbilical artery metabolic acidosis rate declined from 2.5% (average rate of 2000 + 2001 + 2002) to 0.4% (average of 2011 + 2012 + 2013) (P < .001), which represents an 84% decrease. This decrease largely occurred between 2006 and 2008, during the Dutch randomized trial on fetal electrocardiogram ST waveform analysis. At this time, approximately 20% of deliveries were monitored using this method. Furthermore, there were significant reductions in fetal blood sampling rate (P < .001). Overall cesarean and vaginal instrumental deliveries decreased significantly (P < .001), but not for fetal distress. There were no changes in the Apgar scores. The incidence of neonatal encephalopathy was significantly lower in the second part of the study (odds ratio 0.39, 95% confidence interval 0.17–0.89). Conclusion: There was an 84% decrease in the incidence of umbilical artery metabolic acidosis in all deliveries between 2000 and 2013. The neonatal encephalopathy rate, fetal blood sampling rate, and the total number of cesarean and vaginal instrumental deliveries also decreased.
- Published
- 2019
25. Are increased fetal movements always reassuring?
- Author
-
Dan Farine, Gerard H. A. Visser, Clare Whitehead, and Nicole Cohen
- Subjects
medicine.medical_specialty ,Prenatal diagnosis ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,medicine ,Fetal distress ,Humans ,030212 general & internal medicine ,Increased fetal movement ,Fetal Death ,Fetal Movement ,Asphyxia ,Fetus ,030219 obstetrics & reproductive medicine ,Obstetrics ,business.industry ,Pregnancy Outcome ,Obstetrics and Gynecology ,Prenatal Care ,Stillbirth ,medicine.disease ,embryonic structures ,Pediatrics, Perinatology and Child Health ,Fetal movement ,Female ,medicine.symptom ,business ,Nuchal cord - Abstract
Many studies have reported on the association of reduced fetal movements and stillbirth, but little is known about excessive fetal movements and adverse pregnancy outcome. First described in 1977, sudden excessive fetal movement was noted to reflect acute fetal distress and subsequent fetal demise. Subsequently, little was reported regarding this phenomenon until 2012. However, emerging data suggest that 10-30% of the women that subsequently suffer a stillbirth describe a single episode of excessive fetal movement prior to fetal demise. These episodes are poorly understood but may reflect fetal seizure activity secondary to fetal asphyxia, cord entanglement or an adverse intrauterine environment. At present, the challenge in managing women with excessive fetal movements is a timely assessment of the fetus to identify those women at risk of adverse fetal outcomes who may benefit from intervention.
- Published
- 2019
26. European Consensus Guidelines on the Management of Respiratory Distress Syndrome - 2016 Update
- Author
-
Ola Didrik Saugstad, Eren Özek, Gerard H. A. Visser, Richard Plavka, Henry L. Halliday, Virgilio P. Carnielli, Umberto Simeoni, David G. Sweet, Christian P. Speer, Gorm Greisen, Máximo Vento, Mikko Hallman, Sweet, David G., Carnielli, Virgilio, Greisen, Gorm, Hallman, Mikko, Ozek, Eren, Plavka, Richard, Saugstad, Ola Didrik, Simeoni, Umberto, Speer, Christian P., Vento, Maximo, Visser, Gerard H. A., and Halliday, Henry L.
- Subjects
Hyaline membrane disease ,medicine.medical_treatment ,INVASIVE SURFACTANT THERAPY ,Patent ductus arteriosus ,PLACEBO-CONTROLLED TRIAL ,Antenatal steroids ,Mechanical ventilation ,0302 clinical medicine ,Neonatologists ,Obstetrics and gynaecology ,030212 general & internal medicine ,Continuous positive airway pressure ,Disease management (health) ,Respiratory distress ,Disease Management ,Evidence-based practice ,RANDOMIZED CONTROLLED-TRIAL ,Europe ,Preterm infant ,UMBILICAL-CORD MILKING ,Infant, Premature ,BIRTH-WEIGHT INFANTS ,medicine.medical_specialty ,Consensus ,Respiratory distress syndrome ,POSITIVE AIRWAY PRESSURE ,OXYGEN-SATURATION TARGETS ,Lung injury ,Surfactant therapy ,Thermoregulation ,03 medical and health sciences ,030225 pediatrics ,medicine ,Humans ,Intensive care medicine ,Nutrition ,Respiratory Distress Syndrome, Newborn ,EXTREMELY PRETERM INFANTS ,business.industry ,Infant, Newborn ,Infant ,Pulmonary Surfactants ,Oxygen supplementation ,INHALED NITRIC-OXIDE ,CHRONIC LUNG-DISEASE ,Pediatrics, Perinatology and Child Health ,business ,Developmental Biology - Abstract
Advances in the management of respiratory distress syndrome (RDS) ensure that clinicians must continue to revise current practice. We report the third update of the European Guidelines for the Management of RDS by a European panel of expert neonatologists including input from an expert perinatal obstetrician based on available literature up to the beginning of 2016. Optimizing the outcome for babies with RDS includes consideration of when to use antenatal steroids, and good obstetric practice includes methods of predicting the risk of preterm delivery and also consideration of whether transfer to a perinatal centre is necessary and safe. Methods for optimal delivery room management have become more evidence based, and protocols for lung protection, including initiation of continuous positive airway pressure and titration of oxygen, should be implemented from soon after birth. Surfactant replacement therapy is a crucial part of the management of RDS, and newer protocols for surfactant administration are aimed at avoiding exposure to mechanical ventilation, and there is more evidence of differences among various surfactants in clinical use. Newer methods of maintaining babies on non-invasive respiratory support have been developed and offer potential for greater comfort and less chronic lung disease. As technology for delivering mechanical ventilation improves, the risk of causing lung injury should decrease although minimizing the time spent on mechanical ventilation using caffeine and if necessary postnatal steroids are also important considerations. Protocols for optimizing the general care of infants with RDS are also essential with good temperature control, careful fluid and nutritional management, maintenance of perfusion and judicious use of antibiotics all being important determinants of best outcome. (C) 2016 S. Karger AG, Basel
- Published
- 2016
27. The use of actograph in the assessment of fetal well-being
- Author
-
Christoph Lees, Jonathan Lai, Niamh C. Nowlan, Ravi Vaidyanathan, Gerard H. A. Visser, Engineering & Physical Science Research Council (EPSRC), and Imperial Innovations Ltd
- Subjects
Adult ,medicine.medical_specialty ,Middle Cerebral Artery ,Cardiotocography ,Ultrasound scan ,Pregnancy Trimester, Third ,Perinatal risk ,Pulsatility index ,Fetal movements ,Ultrasonography, Prenatal ,Umbilical Arteries ,fetal growth restriction ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,medicine.artery ,medicine ,Humans ,Fetal well being ,030212 general & internal medicine ,Obstetrics & Reproductive Medicine ,Fetal Movement ,Fetus ,030219 obstetrics & reproductive medicine ,Obstetrics ,business.industry ,Obstetrics and Gynecology ,Umbilical artery ,Ultrasonography, Doppler ,Fetal health ,Actigraphy ,Fetal Weight ,Pulsatile Flow ,Pediatrics, Perinatology and Child Health ,Gestation ,1114 Paediatrics and Reproductive Medicine ,Female ,stillbirth ,business ,fetal well-being - Abstract
PURPOSE: Third trimester maternal perception of fetal movements is often used to assess fetal well-being. However, its true clinical value is unknown, primarily because of the variability in subjective quantification. The actograph, a technology available on most cardiotocograph machines, quantifies movements, but has never previously been investigated in relation to fetal health and existing monitoring devices. The objective of this study was to quantify actograph output in healthy third trimester pregnancies and investigate this in relation to other methods of assessing fetal well-being. METHODS: Forty-two women between 24 and 34 weeks of gestation underwent ultrasound scan followed by a computerized cardiotocograph (CTG). Post capture analysis of the actograph recording was performed and expressed as a percentage of activity over time. The actograph output results were analyzed in relation to Doppler, ultrasound and CTG findings expressed as z-score normalized for gestation. RESULTS: There was a significant association between actograph output recording and estimated fetal weight Z-score (R = 0.546, p ≤ .005). This activity was not related to estimated fetal weight. Increased actograph activity was negatively correlated with umbilical artery pulsatility index Z-score (R = -0.306, p = .049) and middle cerebral artery pulsatility index Z-score (R = -0.390, p = .011). CONCLUSION: Fetal movements assessed by the actograph are associated both with fetal size in relation to gestation and fetoplacental Doppler parameters. It is not the case that larger babies move more, however, as the relationship with actograph output related only to estimated fetal weight z-score. These findings suggest a plausible link between the frequency of fetal movements and established markers of fetal health. RATIONALE The objective of this study was to quantify actograph output in healthy third trimester pregnancies and investigate this in relation to other methods of assessing fetal well-being. This is a widely available method of assessing fetal movements objectively, which has been shown to be an important marker of fetal health. This research is novel in the fact that actograph has never been truly investigated in relation to fetal well-being, despite being available on most cardiotocograph (CTG) machines. Our results show that fetal movements assessed by the actograph are associated both with fetal size in relation to gestation and fetoplacental Doppler parameters. If this proves to be true, smaller babies that move less maybe at particular perinatal risk.
- Published
- 2018
28. Heart Rate Changes and Autonomic Nervous System in Fetal Growth Restriction
- Author
-
Karl-Theo Maria Schneider, Silvia M. Lobmaier, and Gerard H. A. Visser
- Subjects
medicine.medical_specialty ,Autonomic nervous system ,business.industry ,Internal medicine ,Heart rate ,medicine ,Cardiology ,Fetal growth ,business - Published
- 2018
29. Placental-Fetal Growth Restriction
- Author
-
Christoph Lees, Gerard H. A. Visser, and Kurt Hecher
- Published
- 2018
30. Reference curves for the normal fetal small bowel and colon diameters; their usefulness in fetuses with suspected dilated bowel
- Author
-
Gwendolyn T. R. Manten, Lourens R. Pistorius, Eduard J. H. Mulder, Charlotte S Voskuilen, Gerard H. A. Visser, and Chiara C. M. M. Lap
- Subjects
Fetus ,medicine.medical_specialty ,business.industry ,Colon ,Ultrasound ,Obstetrics and Gynecology ,digestive system diseases ,Ultrasonography, Prenatal ,Pregnancy ,Reference Values ,Pediatrics, Perinatology and Child Health ,Intestine, Small ,Medicine ,Humans ,Dilated bowel ,Female ,Radiology ,Longitudinal Studies ,Prospective Studies ,business - Abstract
Objectives: To establish reference curves of normal fetal small bowel and colon diameters and to assess the clinical applicability.Method: Serial longitudinal ultrasound examinations at 4-week inte...
- Published
- 2018
31. Diabetes, pregnancy, and the developmental origins of health and disease
- Author
-
Gerard H. A. Visser and Mark A. Hanson
- Subjects
Pediatrics ,medicine.medical_specialty ,business.industry ,Diabetes pregnancy ,Medicine ,Disease ,business - Published
- 2018
32. Monitoring during the later stage of pregnancy and during labor: Glycemic considerations
- Author
-
Harold W. de Valk and Gerard H. A. Visser
- Subjects
Pediatrics ,medicine.medical_specialty ,Pregnancy ,business.industry ,Medicine ,Stage (cooking) ,business ,medicine.disease ,Glycemic - Published
- 2018
33. Ideal weight gain in diabetic pregnancy
- Author
-
Harold W. de Valk and Gerard H. A. Visser
- Subjects
medicine.medical_specialty ,business.industry ,Obstetrics ,Ideal weight ,Medicine ,business ,Diabetic pregnancy - Published
- 2018
34. FIGO analysis of research priorities in hyperglycemia in pregnancy
- Author
-
Anil Kapur, David McIntyre, Fidelma Dunne, Moshe Hod, Gerard H. A. Visser, Gernot Desoye, and Umberto Simeoni
- Subjects
medicine.medical_specialty ,Sociology of scientific knowledge ,Evidence-based practice ,Biomedical Research ,Endocrinology, Diabetes and Metabolism ,MEDLINE ,030209 endocrinology & metabolism ,03 medical and health sciences ,0302 clinical medicine ,Endocrinology ,Pregnancy ,Health care ,Internal Medicine ,medicine ,Humans ,Intensive care medicine ,030219 obstetrics & reproductive medicine ,business.industry ,General Medicine ,medicine.disease ,Pregnancy Complications ,Hyperglycemia ,Female ,Implementation research ,business - Abstract
Hyperglycemia in pregnancy (HIP) is recognized as a major underlying cause of pregnancy complications and a contributing cause to health risks throughout the subsequent life of both mothers and babies, with amplification of the global epidemic of non-communicable diseases. Although some aspects of these associations are well described, detailed understanding of basic pathophysiologic mechanisms is lacking. Improved fundamental scientific knowledge must be developed to allow logical strategies for prevention and treatment. During pregnancy, much work is required to replace current empirical approaches to diagnosis and treatment of HIP with evidence based protocols, pragmatically adapted to differing health care and health economic contexts. Further, a life cycle approach to HIP, the risk of immediate pregnancy complications and later health risks to mother and baby must be developed and implemented across a wide range of health care environments. This document aims to outline key focus areas for further basic, epidemiologic, clinical and implementation research in this important area.
- Published
- 2018
35. Outcome in early-onset fetal growth restriction is best combining computerized fetal heart rate analysis with ductus venosus Doppler: insights from the Trial of Umbilical and Fetal Flow in Europe
- Author
-
Neil Marlow, Aleid G. van Wassenaer-Leemhuis, Baskaran Thilaganathan, Kurt Hecher, Johannes J. Duvekot, Tullia Todros, E. Ostermayer, Jim G Thornton, J. W. Ganzevoort, Birgit Arabin, Gerard H. A. Visser, Dietmar Schlembach, Aris T. Papageorghiou, Tiziana Frusca, Christoph Brezinka, Christoph Lees, Caterina M. Bilardo, Hans Wolf, Herbert Valensise, Enrico Ferrazzi, Karel Marsal, Anke Diemert, Jan Derks, and Pasquale Martinelli
- Subjects
Biophysical profile ,Trial of Umbilical and Fetal Flow in Europe ,Middle Cerebral Artery ,Umbilical Veins ,Cardiotocography ,Intrauterine growth restriction ,law.invention ,0302 clinical medicine ,Randomized controlled trial ,law ,Pregnancy ,Heart Rate ,1114 Paediatrics And Reproductive Medicine ,Laser-Doppler Flowmetry ,Medicine ,Birth Weight ,Prenatal ,030212 general & internal medicine ,GESTATION ,PREDICTORS ,Randomized Controlled Trials as Topic ,Ultrasonography ,RISK ,030219 obstetrics & reproductive medicine ,Fetal Growth Retardation ,medicine.diagnostic_test ,Obstetrics ,Doppler ,Obstetrics and Gynecology ,Disease Management ,Heart Rate, Fetal ,perinatal outcome ,Settore MED/40 ,Pregnancy Trimester, Second ,Pulsatile Flow ,Gestation ,Premature Birth ,Female ,Pregnancy Trimester ,Acidosis ,INTERVENTION ,Delivery ,Ductus venosus ,medicine.medical_specialty ,Fetal Heart Rate Variability ,intrauterine growth restriction ,Pregnancy Trimester, Third ,neurodevelopmental handicap ,PARAMETERS ,Ultrasonography, Prenatal ,Fetal ,03 medical and health sciences ,AGE ,BIOPHYSICAL PROFILE ,FETUSES ,Humans ,Obstetrics & Reproductive Medicine ,Fetal Death ,ARTERY ,Third ,Fetus ,umbilical artery Doppler ,business.industry ,Ultrasonography, Doppler ,Obstetric ,Second ,Delivery, Obstetric ,medicine.disease ,antepartum surveillance ,cardiotocography ,NEONATAL MORBIDITY ,business - Abstract
Background: Early-onset fetal growth restriction represents a particular dilemma in clinical management balancing the risk of iatrogenic prematurity with waiting for the fetus to gain more maturity, while being exposed to the risk of intrauterine death or the sequelae of acidosis. Objective: The Trial of Umbilical and Fetal Flow in Europe was a European, multicenter, randomized trial aimed to determine according to which criteria delivery should be triggered in early fetal growth restriction. We present the key findings of the primary and secondary analyses. Study Design: Women with fetal abdominal circumference 95th percentile between 26-32 weeks were randomized to 1 of 3 monitoring and delivery protocols. These were: fetal heart rate variability based on computerized cardiotocography; and early or late ductus venosus Doppler changes. A safety net based on fetal heart rate abnormalities or umbilical Doppler changes mandated delivery irrespective of randomized group. The primary outcome was normal neurodevelopmental outcome at 2 years. Results: Among 511 women randomized, 362/503 (72%) had associated hypertensive conditions. In all, 463/503 (92%) of fetuses survived and cerebral palsy occurred in 6/443 (1%) with known outcome. Among all women there was no difference in outcome based on randomized group; however, of survivors, significantly more fetuses randomized to the late ductus venosus group had a normal outcome (133/144; 95%) than those randomized to computerized cardiotocography alone (111/131; 85%). In 118/310 (38%) of babies delivered
- Published
- 2018
36. FIGO position paper: how to stop the caesarean section epidemic
- Author
-
Salimah R. Walani, Wanda K. Nicholson, Gian Carlo Di Renzo, Luming Sun, Gerhard Theron, Luc de Bernis, Isabel Lloyd, Anwar H. Nassar, Maria Fernanda Escobar Vidarte, William Stones, Gerard H. A. Visser, P.K. Shah, Eytan R. Barnea, and Diogo Ayres-de-Campos
- Subjects
Health Knowledge, Attitudes, Practice ,medicine.medical_specialty ,medicine.medical_treatment ,MEDLINE ,Health knowledge ,Global Health ,Health Services Misuse ,Obstetric care ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,Global health ,Humans ,Medicine ,Caesarean section ,030212 general & internal medicine ,Practice Patterns, Physicians' ,030219 obstetrics & reproductive medicine ,Cesarean Section ,Practice patterns ,business.industry ,Obstetrics ,Medicine (all) ,Prenatal Care ,General Medicine ,medicine.disease ,Position paper ,Female ,business - Published
- 2018
37. Maternal allopurinol administration during suspected fetal hypoxia: a novel neuroprotective intervention? A multicentre randomised placebo controlled trial
- Author
-
Carin M. A. Rademaker, Danilo Gavilanes, Ewoud Schuit, Janine Boon, Timo R. de Haan, Joepe J. Kaandorp, Maureen T.M. Franssen, Claudia A. van Meir, Maurice G.A.J. Wouters, Kitty W. M. Bloemenkamp, Saskia C. M. J. E. R. Bakker, Liesbeth Scheepers, Inge P. de Boer, Robbert J.P. Rijnders, Martijn A. Oudijk, Sidarto Bambang Oetomo, Ruurd M. van Elburg, Corrie J. W. F. M. Jacobs, Monique Rijken, Manon J.N.L. Benders, Gerard H. A. Visser, Frank van Bel, Jeannette S von Lindern, Jan B. Derks, Arie Bos, Anjoke J.M. Huisjes, Ben W.J. Mol, Martina Porath, Obstetrics and gynaecology, ICaR - Ischemia and repair, Other departments, ARD - Amsterdam Reproduction and Development, Obstetrics and Gynaecology, ANS - Amsterdam Neuroscience, Other Research, Neonatology, Reproductive Origins of Adult Health and Disease (ROAHD), MUMC+: MA Medische Staf Obstetrie Gynaecologie (9), Obstetrie & Gynaecologie, Epidemiologie, Kindergeneeskunde, and RS: FHML non-thematic output
- Subjects
Adult ,Male ,BIOMARKER ,Xanthine Oxidase ,Allopurinol ,Placebo-controlled study ,Oxypurinol ,S100 Calcium Binding Protein beta Subunit ,Placebo ,Dinoprost ,Fetal Hypoxia ,BRAIN-DAMAGE ,Double-Blind Method ,Pregnancy ,S100B PROTEIN ,Post-hoc analysis ,REGRESSION ,medicine ,Clinical endpoint ,Humans ,Enzyme Inhibitors ,Maternal-Fetal Exchange ,Aldehydes ,PERINATAL ASPHYXIA ,CEREBRAL-ISCHEMIA ,business.industry ,Obstetrics and Gynecology ,ENCEPHALOPATHY ,General Medicine ,Ketones ,medicine.disease ,Fetal Blood ,Perinatal asphyxia ,BIRTH ASPHYXIA ,BLOOD-LEVELS ,BIOLOGICAL-FLUIDS ,Anesthesia ,Cord blood ,Relative risk ,Pediatrics, Perinatology and Child Health ,Female ,business ,medicine.drug - Abstract
Objective To determine whether maternal allopurinol treatment during suspected fetal hypoxia would reduce the release of biomarkers associated with neonatal brain damage.Design A randomised double-blind placebo controlled multicentre trial.Patients We studied women in labour at term with clinical indices of fetal hypoxia, prompting immediate delivery.Setting Delivery rooms of 11 Dutch hospitals.Intervention When immediate delivery was foreseen based on suspected fetal hypoxia, women were allocated to receive allopurinol 500 mg intravenous (ALLO) or placebo intravenous (CONT).Main outcome measures Primary endpoint was the difference in cord 510013, a tissue-specific biomarker for brain damage.Results 222 women were randomised to receive allopurinol (ALLO, n=111) or placebo (CONT, n=111). Cord S100ss was not significantly different between the two groups: 44.5 pg/mL (IQR 20.2-71.4) in the ALLO group versus 54.9 pg/mL (IQR 26.8-94.7) in the CONT group (difference in median -7.69 (95% Cl -24.9 to 9.52)). Post hoc subgroup analysis showed a potential treatment effect of allopurinol on the proportion of infants with a cord S100ss value above the 75th percentile in girls (ALLO n=5 (12%) vs CONT n=10 (31%); risk ratio (RR) 0.37 (95% Cl 0.14 to 0.99)) but not in boys (ALLO n=18 (32%) vs CONT n=15 (25%); RR 1.4(95% Cl 0.84 to 2.3)). Also, cord neuroketal levels were significantly lower in girls treated with allopurinol as compared with placebo treated girls: 18.0 pg/mL (95% Cl 12.1 to 26.9) in the ALLO group versus 32.2 pg/mL (95% Cl 22.7 to 45.7) in the CONT group (geometric mean difference 16.4(95% Cl 24.6 to 1.64)).Conclusions Maternal treatment with allopurinol during fetal hypoxia did not significantly lower neuronal damage markers in cord blood. Post hoc analysis revealed a potential beneficial treatment effect in girls. Trial registration number NCT00189007, Dutch Trial Register NTR1383.
- Published
- 2015
38. Determinants of first trimester combined test participation within the central region of the Netherlands
- Author
-
P. C. J. I. Schielen, Jozien M. Bensing, Rita Iedema, Philip Stoutenbeek, Maria P.H. Koster, Chantal W P M Hukkelhoven, Gerard H. A. Visser, and Neeltje Crombag
- Subjects
Pediatrics ,medicine.medical_specialty ,Pregnancy ,Down syndrome ,Multivariate analysis ,business.industry ,Ethnic group ,Obstetrics and Gynecology ,Prenatal diagnosis ,medicine.disease ,Risk perception ,medicine ,Advanced maternal age ,Parity (mathematics) ,business ,Genetics (clinical) ,Demography - Abstract
ObjectiveOur objective is to study the association between potentially influential determinants and first-trimester combined test (FCT) uptake rates in the central region of the Netherlands. MethodsData were extracted from the national prenatal screening database Peridos and the Netherlands Perinatal Registry and compared at the level of the health care provider. Univariable and multivariable linear regression analysis was used to determine the effect of determinants (maternal age, parity, socio-economic status (SES), mode of conception, ethnicity and urbanisation) on uptake. ResultsPrenatal screening data were available for 24657 women and overall uptake rate was 25.7%. The strongest association with FCT uptake was found for advanced maternal age ( 2.2; 95% CI [1.7, 2.8]). Grand multiparity had a significantly negative association with FCT uptake ( -4.3; 95% CI [-5.9, -2.7]). Positive associations were found for very high urbanisation ( 0.3; 95% CI [0.1, 0.4]) and high SES ( 0.2; 95% CI [0.0, 0.3]). ConclusionAdvanced maternal age is strongly associated with participation in prenatal testing. The role of age related risk perception should be incorporated in future policy making to support women in informed and autonomous decision making. The negative association of grand multiparity and FCT might be religion based but requires further research. (c) 2015 John Wiley & Sons, Ltd.
- Published
- 2015
39. Management of diabetes in pregnancy: Antenatal follow-up and decisions concerning timing and mode of delivery
- Author
-
Harold W. de Valk and Gerard H. A. Visser
- Subjects
medicine.medical_specialty ,endocrine system diseases ,Pregnancy in Diabetics ,Hypoglycemia ,Pregnancy ,Diabetes mellitus ,medicine ,Fetal macrosomia ,Humans ,Mass index ,business.industry ,Obstetrics ,Incidence (epidemiology) ,Pregnancy Outcome ,Obstetrics and Gynecology ,Prenatal Care ,General Medicine ,Delivery, Obstetric ,medicine.disease ,Gestational diabetes ,Diabetes Mellitus, Type 1 ,Diabetes Mellitus, Type 2 ,Female ,Metabolic syndrome ,business - Abstract
Pregnancy in women with diabetes remains complicated despite improvements in glucose control. This seems mainly due to the fact that normoglycemia is still outside of reach. Congenital malformations are already significantly increased in the case of HbA1c values of 2-4SD above the mean, and fetal macrosomia is increasing in incidence. The latter may be due to an increase in maternal body mass index (BMI), absence of cardiovascular complications, better placentation, and increased weight gain during pregnancy. Severe maternal hypoglycemia is a frequent complication during the first trimester of pregnancy. The outcome is generally poorer in the case of type-2 diabetes as compared to type-1, which is likely to be due to a higher incidence of maternal metabolic syndrome. In this article, preconceptional and antenatal management and the mode and timing of delivery are discussed, both for women with preexisting diabetes and for those with gestational diabetes mellitus.
- Published
- 2015
40. Antenatal Maternal Antidepressants Drugs Affect S100B Concentrations in Fetal-Maternal Biological Fluids
- Author
-
Marja van der Heide, Diego Gazzolo, Tessa Ververs, Valentina Bellissima, Gerard H. A. Visser, Frank van Bel, and Jacqueline U.M. Termote
- Subjects
Adult ,medicine.medical_specialty ,Time Factors ,Amniotic fluid ,Brain damage ,Statistics, Nonparametric ,Young Adult ,Venous Cord Blood ,Pregnancy ,medicine ,Humans ,Pharmacology ,Fetus ,Depression ,Obstetrics ,business.industry ,General Neuroscience ,S100 Proteins ,Infant, Newborn ,Fetal Blood ,medicine.disease ,Antidepressive Agents ,Maternal-Fetal Relations ,Antidepressant ,Female ,Observational study ,Serotonin ,medicine.symptom ,business ,Selective Serotonin Reuptake Inhibitors - Abstract
Introduction: Antidepressant treatment during pregnancy is speedily increasing in developed countries and this phenomenon has occurred without firm evidence on safety and/or efficacy. Aims: The present study investigated from mid-trimester of pregnancy up to 24 hours after birth the pattern of a brain damage marker, namely S100B, in maternal fetal and neonatal biological fluids of pregnant women and their newborns antenatally treated by antidepressant drugs such as selective serotonin re-uptake inhibitors (SSRI). Methods: we conducted an observational study on 75 pregnant women treated in the mid –third trimester by antidepressant drugs and 231 healthy pregnancies. S100B concentrations were measured at 7 predetermined monitoring time-points before, during and after treatment in maternal, fetal and neonatal biological fluids and correlated with neurological follow-up at 7 days from birth. Results: In SSRI group S100B concentrations were significantly higher in SSRI than controls (P
- Published
- 2015
41. Human fetal growth is constrained below optimal for perinatal survival
- Author
-
Blanka Vasak, Arie Franx, Steven V. Koenen, Chantal W P M Hukkelhoven, Maria P.H. Koster, Gerard H. A. Visser, and Mark A. Hanson
- Subjects
Pediatrics ,medicine.medical_specialty ,Fetus ,education.field_of_study ,Radiological and Ultrasound Technology ,Singleton ,Obstetrics ,business.industry ,Birth weight ,Population ,Obstetrics and Gynecology ,Gestational age ,General Medicine ,Reproductive Medicine ,Perinatal survival ,Human fetal ,medicine ,Gestation ,Radiology, Nuclear Medicine and imaging ,education ,business - Abstract
Objective The use of fetal growth charts assumes that the optimal size at birth is at the 50 th birth-weight centile, but interaction between maternal constraints on fetal growth and the risks associated with small and large fetal size at birth may indicate that this assumption is not valid for perinatal mortality rates. The objective of this study was to investigate the distribution and timing (antenatal, intrapartum or neonatal) of perinatal mortality and morbidity in relation to birth weight and gestational age at delivery. Methods Data from over 1 million births occurring at 28–43 weeks’ gestation from singleton pregnancies without congenital abnormalities in the period from 2002 to 2008 were collected from The Netherlands Perinatal Registry. The distribution of perinatal mortality according to birth-weight centile and gestational age at delivery was studied. Results In the 1 170 534 pregnancies studied, there were 5075 (0.43%) perinatal deaths. The highest perinatal mortality occurred in those with a birth weight below the 2.3 rd centile (25.4/1000 births) and the lowest mortality was in those with birth weights between the 80 th and 84 th centiles (2.4/1000 births), according to routinely used growth charts. Antepartum deaths were lowest in those with birth weight between the 90 th and 95 th centiles. Data were almost identical when the analysis was restricted to infants born at ≥ 37 weeks’ gestation. Conclusion From an immediate survival perspective, optimal fetal growth requires a birth weight between the 80 th and 84 th centiles for the population. Median birth weight in the population is, by definition, substantially lower than these centiles, implying that the majority of fetuses exhibit some form of maternal constraint on
- Published
- 2015
42. Cerebral and somatic NIRS-determined oxygenation in IUGR preterm infants during transition
- Author
-
Gerard H. A. Visser, Giuseppe Paterlini, Lorenzo Tosetti, Frank van Bel, Paolo Tagliabue, Diego Gazzolo, and Valentina Bozzetti
- Subjects
Male ,03 medical and health sciences ,0302 clinical medicine ,Growth restriction ,030225 pediatrics ,Fetal growth ,Humans ,Medicine ,Prospective Studies ,Splanchnic Circulation ,Brain sparing ,Fetal Growth Retardation ,Spectroscopy, Near-Infrared ,030219 obstetrics & reproductive medicine ,business.industry ,Infant, Newborn ,Obstetrics and Gynecology ,Oxygenation ,Oxygen ,Perinatal morbidity ,Case-Control Studies ,Cerebrovascular Circulation ,Anesthesia ,Pediatrics, Perinatology and Child Health ,Female ,Splanchnic ,business ,Infant, Premature - Abstract
Fetal growth restriction (intra-uterine growth restriction [IUGR]) has a considerable impact on perinatal morbidity. Preterm IUGR infants are prone to impaired intestine function. Near-infrared spectroscopy (NIRS) has been used to monitor oxygenation status of the brain and of the intestine.We conducted a prospective case-control study at our NICU in 20 preterm infants of whom 10 infants complicated by compared with 10 non-IUGR preterm infants. Splanchnic and cerebral regional oximetry values were measured with NIRS. Three hours of consecutive recordings were performed in the first 24 h of life, T0, and during the transitional period, T1. The cerebral/splanchnic oxygenation ratio, CSOR, (cerebral regional saturations [rScO2]/splanchnic regional saturations [rSsO2]) was also calculated.Both in the IUGR and the non-IUGR infants, at T0 and T1 monitoring time-points, the rSO2 values were higher in the cerebral district when compared to those of the splanchnic area. Comparison of the NIRS parameters between the IUGR and non-IUGR infants at T0 showed no difference in rScO2, while rSsO2 was significantly lower in the IUGR group. At T1, rScO2 was significantly lower and rSsO2 higher in the IUGR group.Cerebral/splanchnic vascular adaptation of IUGR infants to the extra-uterine environment is characterized by a postnatal persistence of the brain sparing effect with reperfusion in the transitional period.
- Published
- 2015
43. The added predictive value of biphasic events in ST analysis of the fetal electrocardiogram for intrapartum fetal monitoring
- Author
-
Karel Marsal, Anneke Kwee, Anniek Krikhaar, Annika Mårtendal, Isis Amer-Wåhlin, Jeroen H. Becker, Ewoud Schuit, and Gerard H. A. Visser
- Subjects
medicine.medical_specialty ,Neonatal intensive care unit ,Cardiotocography ,Umbilical cord ,Fetal Distress ,neonatal outcome ,Electrocardiography ,Fetal Heart ,Pregnancy ,Biphasic events ,Journal Article ,medicine ,Fetal distress ,Humans ,Fetal Monitoring ,Fetus ,medicine.diagnostic_test ,Obstetrics ,business.industry ,fetal electrocardiogram ,Pregnancy Outcome ,Obstetrics and Gynecology ,General Medicine ,Odds ratio ,medicine.disease ,ST-analysis ,medicine.anatomical_structure ,Area Under Curve ,Randomized Controlled Trial ,Female ,Apgar score ,business - Abstract
OBJECTIVE: To study the predictive value of biphasic ST-events for interventions for suspected fetal distress and adverse neonatal outcome, when using ST-analysis of the fetal electrocardiogram (FECG) for intrapartum fetal monitoring. DESIGN: Prospective cohort study. SETTING: Three academic hospitals in Sweden. POPULATION: Women in labor with a high-risk singleton fetus in cephalic position beyond 36 weeks of gestation. METHODS: In women in labor who were monitored with conventional cardiotocography, ST-waveform analysis was recorded and concealed. Traces with biphasic ST-events of the FECG (index) were compared with traces without biphasic events of the FECG. The ability of biphasic events to predict interventions for suspected fetal distress and adverse outcome was assessed using univariable and multivariable logistic regression analyses. MAIN OUTCOME MEASURES: Interventions for suspected fetal distress and adverse outcome (defined as presence of metabolic acidosis (i.e. umbilical cord pH 12 mmol), umbilical cord pH
- Published
- 2014
44. Identification of first stage labor arrest by electromyography in term nulliparous women after induction of labor
- Author
-
Elske Hekman-Drost, Marinus J.C. Eijkemans, Elisabeth M. Graatsma, Benoit C. Jacod, Gerard H. A. Visser, Jules H. Schagen van Leeuwen, and Blanka Vasak
- Subjects
Adult ,induction of labor ,medicine.medical_specialty ,Vascular damage Radboud Institute for Health Sciences [Radboudumc 16] ,Observational Study ,Prenatal diagnosis ,Electromyography ,Uterine Contraction ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,Prenatal Diagnosis ,medicine ,Journal Article ,Humans ,Labor, Induced ,Prospective Studies ,030212 general & internal medicine ,Young adult ,Prospective cohort study ,parturition ,reproductive and urinary physiology ,Netherlands ,Gynecology ,Fetus ,030219 obstetrics & reproductive medicine ,medicine.diagnostic_test ,business.industry ,Myometrium ,Obstetrics and Gynecology ,Cesarean delivery ,General Medicine ,Middle Aged ,medicine.disease ,laborarrest ,Obstetric Labor Complications ,Multicenter Study ,Parity ,Oxytocin ,Female ,Labor Stage, First ,business ,uterine electromyography ,medicine.drug - Abstract
Contains fulltext : 174756.pdf (Publisher’s version ) (Closed access) INTRODUCTION: Worldwide induction and cesarean delivery rates have increased rapidly, with consequences for subsequent pregnancies. The majority of intrapartum cesarean deliveries are performed for failure to progress, typically in nulliparous women at term. Current uterine registration techniques fail to identify inefficient contractions leading to first-stage labor arrest. An alternative technique, uterine electromyography has been shown to identify inefficient contractions leading to first-stage arrest of labor in nulliparous women with spontaneous onset of labor at term. The objective of this study was to determine whether this finding can be reproduced in induction of labor. MATERIAL AND METHODS: Uterine activity was measured in 141 nulliparous women with singleton term pregnancies and a fetus in cephalic position during induced labor. Electrical activity of the myometrium during contractions was characterized by its power density spectrum. RESULTS: No significant differences were found in contraction characteristics between women with induced labor delivering vaginally with or without oxytocin and women with arrested labor with subsequent cesarean delivery. CONCLUSION: Uterine electromyography shows no correlation with progression of labor in induced labor, which is in contrast to spontaneous labor.
- Published
- 2017
45. FIGO's updated recommendations for misoprostol used alone in gynecology and obstetrics
- Author
-
Beverly Winikoff, Jessica L. Morris, Gerard H. A. Visser, Kristina Gemzell-Danielsson, Rasha Dabash, Laura Castleman, Anibal Faundes, Caron Kim, Nathalie Kapp, Andrew Weeks, and Pak Chung Ho
- Subjects
Gynecology ,medicine.medical_specialty ,030219 obstetrics & reproductive medicine ,business.industry ,Obstetrics ,MEDLINE ,Obstetrics and Gynecology ,General Medicine ,03 medical and health sciences ,0302 clinical medicine ,Medicine ,030212 general & internal medicine ,business ,Misoprostol ,medicine.drug - Published
- 2017
46. Holder pasteurization affects S100B concentrations in human milk
- Author
-
Enrico Bertino, Fabio Galvano, Chiara Peila, Alessandra Coscia, Gerard H. A. Visser, Giovanni Li Volti, and Diego Gazzolo
- Subjects
0301 basic medicine ,Adult ,Brain development ,Central nervous system, donor human milk, human milk, pasteurization holder, S100B ,Pasteurization ,S100 Calcium Binding Protein beta Subunit ,Central nervous system ,donor human milk ,human milk ,pasteurization holder ,S100B ,Pediatrics, Perinatology and Child Health ,Obstetrics and Gynecology ,Pediatrics ,law.invention ,Hop (networking) ,03 medical and health sciences ,0302 clinical medicine ,law ,Pregnancy ,Freezing ,Medicine ,Humans ,Food science ,S100b protein ,Holder pasteurization ,Milk, Human ,business.industry ,Hormones levels ,Infant, Newborn ,Perinatology and Child Health ,030104 developmental biology ,Milk Banks ,Case-Control Studies ,Female ,business ,030217 neurology & neurosurgery - Abstract
Donor milk (DM) represents an important nutrition source for high-risk newborns. Holder pasteurization (HoP) is the most recommended procedure for DM treatment, providing a good compromise between microbiological safety and biological quality. HoP was previously shown to affect DM cytokines, growth factors and hormones levels, whilst no data concerning the possible effects of HoP on neurobiomarkers (NB) are available. Therefore, our study investigated whether the concentration in DM of a well-known NB involved in brain development/damage, namely S100B, changes due to HoP.We conducted a pretest-test study in 11 mothers, whose DM samples were sub-divided into two parts: the first was immediately frozen (-80 °C); the second was pasteurized with Holder method before freezing. S100B DM levels were measured using a commercially available immunoluminometric assay.S100B protein was detected in all milk samples. Results showed significant differences between groups (p 0.05) in S100B levels after HoP.Our data provide evidence that S100B is present in preterm milk as well as in term milk during maturation degree. Moreover, the results confirm the susceptibility of this neurotrophic factor to pasteurization stresses and the need to develop new storage techniques to preserve the biological quality of human milk.
- Published
- 2017
47. Fetal Distress and Labor Management: The Role of Intrapartum Monitoring
- Author
-
Gerard H. A. Visser
- Subjects
congenital, hereditary, and neonatal diseases and abnormalities ,medicine.medical_specialty ,medicine.diagnostic_test ,Obstetrics ,business.industry ,Perinatal outcome ,medicine.disease ,Infant mortality ,Early neonatal death ,Cerebral palsy ,Labor management ,Obstetrics and gynaecology ,medicine ,Fetal distress ,Cardiotocography ,business - Abstract
Electronic fetal heart rate monitoring or cardiotocography (CTG) has been introduced in the 1970s. It has resulted in a 1.6-fold increase in cesarean deliveries (CD; [1]) for fetal distress but has hardly resulted in improvements in neonatal outcome. As stated in an editorial in the American Journal of Obstetrics and Gynecology, “ The hope that this technology would lower the rate of cerebral palsy from intrapartum asphyxia has not materialized. There is, however, reasonable good evidence that CTG does decrease the rate of perinatal mortality, particularly early infant death because of hypoxia” [2]. At term approximately 11,000 labors should be monitored to prevent one early neonatal death and 4,000 to prevent one infant death [3]. In other words, the contribution of CTG to improve perinatal outcome seems rather restricted. And for the prevention of one neonatal death, an extra 700 CDs will have to be performed. In this chapter, the backgrounds of the disappointing effects of CTG monitoring on perinatal outcome are discussed, and suggestions for improvements are given.
- Published
- 2017
48. Women Are Designed to Deliver Vaginally and Not by Cesarean Section: An Obstetrician's View
- Author
-
Gerard H. A. Visser
- Subjects
medicine.medical_specialty ,Offspring ,Maternal Health ,Maternal morbidity ,Childhood obesity ,Time ,Child Development ,Obstetrics and gynaecology ,Pregnancy ,medicine ,Humans ,Infant Health ,Natural Childbirth ,Cesarean delivery ,Gynecology ,Cesarean Section ,business.industry ,Obstetrics ,Infant, Newborn ,Pregnancy Outcome ,Natural childbirth ,medicine.disease ,Neonatal morbidity ,Pediatrics, Perinatology and Child Health ,Female ,business ,Developmental Biology - Abstract
Worldwide, there is a rapid increase in deliveries by cesarean section. The large differences among countries, from about 16% to more than 60%, suggest that the cesarean delivery (CD) rate has little to do with evidence-based medicine. In this review, the background for the increasing CD rate is discussed as well as the limited positive effects on neonatal outcome in both term and preterm neonates. Negative effects of CD, including direct maternal morbidity, complications of subsequent pregnancies and iatrogenic early delivery resulting in increased neonatal morbidity, are discussed in addition to long-term implications for the offspring involving altered development of the immune system. The ‘battle' to lower the CD rate will be difficult, but we should not forget that women are designed to deliver vaginally and not by cesarean section.
- Published
- 2014
49. It is time to introduce ST analysis for fetal monitoring in the labor ward?
- Author
-
Jörg Kessler and Gerard H. A. Visser
- Subjects
medicine.medical_specialty ,Cardiotocography ,Cost-Benefit Analysis ,Fetal heart rate monitoring ,Fetal asphyxia ,Sensitivity and Specificity ,law.invention ,Fetal monitoring ,Asphyxia ,Electrocardiography ,Randomized controlled trial ,Pregnancy ,law ,medicine ,Humans ,Intensive care medicine ,St analysis ,medicine.diagnostic_test ,business.industry ,Reproducibility of Results ,Obstetrics and Gynecology ,General Medicine ,Fetal electrocardiogram ,Delivery, Obstetric ,embryonic structures ,Fetal outcome ,Female ,business - Abstract
Five randomized controlled trials have been published on intrapartum fetal heart rate monitoring with ST analysis of the fetal electrocardiogram, but the debate on its usefulness has not yet been ended. We consider ST analysis a useful and cost-effective addition to conventional fetal heart rate monitoring. We will provide support for this opinion by discussing the pathophysiology of ST changes in relation to fetal asphyxia, the results of the randomized controlled trials and numerous meta-analyses of these randomized controlled trials and trends in fetal outcome in hospitals in different countries following the introduction of the ST technology in the labor ward.
- Published
- 2014
50. Title Pages / Tables of Contents
- Author
-
Sonia S. Hassan, Roberto Romero, Gerard H. A. Visser, Sean Seeho, A. Özgür Yeniel, Arlene M D'Silva, Stefania Triunfo, Donna Lai, Francesc Figueras, Sermet Sagol, Jon Hyett, Suzanne M. Jacques, Eduard Gratacós, M. Sanz-Cortes, Elena Demicheva, Christopher Lees, Gaiane Demirdjian, S. Savchev, Leona Poon, Caterina M. Bilardo, William Mifsud, Fatima Crispi, Marta Nucci, Lami Yeo, Cecilia H. M. Ng, Neil J. Sebire, Ahmet Baschat, Cem Yasar Sanhal, Fuat Akercan, Francesc Botet, Hyunyoung Ahn, Amin Sabri, Druckerei Stückle, Maynor Garcia, Satz Mengensatzproduktion, Mert Kazandi, Faisal Qureshi, Edgar Hernandez-Andrade, Monica Cruz-Lemini, Kypros H. Nicolaides, Alma Aurioles-Garibay, Jasjot Kaur, Bruno Darbouret, Ali Akdemir, and A. Mete Ergenoglu
- Subjects
Embryology ,business.industry ,Pediatrics, Perinatology and Child Health ,Obstetrics and Gynecology ,Library science ,Medicine ,Radiology, Nuclear Medicine and imaging ,General Medicine ,business - Published
- 2014
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.