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1. Ethiopian Anesthetist Licensing Examination: A Qualitative Study of Concerns and Unintended Consequences

Author

Asemu YM, Yigzaw T, Ayalew F, Akalu L, Scheele F, and van den Akker T

Subjects
anesthesia, anesthetist, associate clinician, non-physician, licensing examination, Special aspects of education, LC8-6691, Medicine (General), R5-920
Abstract

Yohannes Molla Asemu,1,2 Tegbar Yigzaw,1 Firew Ayalew,1 Leulayehu Akalu,3,4 Fedde Scheele,2,5,6 Thomas van den Akker2,7 1Health Workforce Improvement Program, Jhpiego, An Affiliate of Johns Hopkins University, Ethiopia Country Office, Addis Ababa, Ethiopia; 2Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; 3Ethiopian Association of Anesthetists (EAA), Addis Ababa, Ethiopia; 4School of Anesthesia, Addis Ababa University, Addis Ababa, Ethiopia; 5Department of Obstetrics and Gynecology, OLVG Teaching Hospital, Amsterdam, the Netherlands; 6Department of Obstetrics and Gynecology, Amsterdam University Medical Center (AUMC), Amsterdam, the Netherlands; 7Department of Obstetrics and Gynecology, Leiden University Medical Centre (LUMC), Leiden, the NetherlandsCorrespondence: Yohannes Molla Asemu, Health Workforce Improvement Program, Jhpiego, an affiliate of Johns Hopkins University, Ethiopia Country Office, Kirkos Sub-City, Kebele 02/03, House 693, Wollo Sefer, Addis Ababa, Ethiopia, Tel +251911384046, Email Yohannes.Asemu@jhpiego.orgBackground: Ethiopia increased its anesthesia workforce drastically by expanding the training of associate clinician anesthetists. Following this expansion, the Ministry of Health established an entry-level anesthesia licensing examination to ensure patient safety. However, there is limited empirical evidence on the impacts of licensing exams in low- and middle-income countries. This study aimed to explore the concerns and undesirable consequences of the anesthetist licensing examination in Ethiopia.Methods: A qualitative design using a grounded theory approach was employed by collecting data from 10 anesthesia teaching institutions. We conducted 15 in-depth interviews with instructors and six focus groups with students and graduates who took the exam recently. Interviews and focus groups were audio-recorded, transcribed verbatim, and analyzed using Atlas.ti 23. We also extracted secondary data from the academic committee meeting minutes, curricula, faculty appraisal reports, and program quality self-review reports.Results: Qualitative analysis revealed three central categories of concerns and untoward consequences of the anesthetist NLE: exam management, educational management, and student behavior. Exam management concerns were related to exam validity, fairness, and consistent enforcement of pass/fail decisions. The unintended consequences of the exam on education management were perceived as promoting teaching and learning for the exam, increasing faculty workload, and resulting in superficial and patchy educational reforms. Study participants also reported adverse psychosocial effects and increased cheating behaviors among students as undesirable consequences of the exam on student behavior.Conclusion: Our study identified some concerns and unintended consequences of the Ethiopian anesthetist licensing examination. These lessons learned may contribute to improving the quality of licensing examinations in Ethiopia and beyond.Keywords: anesthesia, anesthetist, associate clinician, non-physician, licensing examination

Published
2023

2. The Ethiopian Anesthetist Licensing Examination and Associated Improvement in in-School Student Performance: A Retrospective Study

Author

Asemu YM, Yigzaw T, Ayalew F, Akalu L, Scheele F, and van den Akker T

Subjects
anesthesia, anesthetist, associate clinician, non-physician, licensing examination, Special aspects of education, LC8-6691, Medicine (General), R5-920
Abstract

Yohannes Molla Asemu,1,2 Tegbar Yigzaw,1 Firew Ayalew,1 Leulayehu Akalu,3,4 Fedde Scheele,2,5,6 Thomas van den Akker2,7 1Health Workforce Improvement Program, Jhpiego, an Affiliate of Johns Hopkins University, Ethiopia Country Office, Addis Ababa, Ethiopia; 2Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; 3Ethiopian Association of Anesthetists (EAA), Addis Ababa, Ethiopia; 4School of Anesthesia, Addis Ababa University, Addis Ababa, Ethiopia; 5Department of Obstetrics and Gynecology, OLVG Teaching Hospital, Amsterdam, the Netherlands; 6Department of Obstetrics and Gynecology, Amsterdam University Medical Center (AUMC), Amsterdam, the Netherlands; 7Department of Obstetrics and Gynecology, Leiden University Medical Centre (LUMC), Leiden, the NetherlandsCorrespondence: Yohannes Molla Asemu, Jhpiego, an Affiliate of Johns Hopkins University, Ethiopia Country Office, Kirkos Sub-City, Kebele 02/03, House 693, Wollo Sefer, Addis Ababa, Ethiopia, Tel +251 911384046, Email Yohannes.Asemu@jhpiego.orgBackground: Ethiopia introduced a national licensing examination (NLE) in response to growing concerns about the competence of graduates and the quality of education. This study aimed to assess the associated in-school student performance changes in anesthetist training programs following NLE implementation.Methods: Academic records of 1493 graduate anesthetists were retrospectively obtained from eight universities before (n=932) and after (n=561) NLE implementation. Four universities were first-generation (oldest), three were second-generation, and one was third-generation (newest). We compared the yearly (Y1 to Y4) and cumulative grade point averages (GPA) to assess if there were in-school student performance differences between the two periods. The Kruskal–Wallis and Mann–Whitney U-tests were used to compare groups. Results are presented as a median, interquartile range, a 95% confidence interval (CI) for median differences, and Cohen’s r effect size.Results: Overall, there was a small to moderate improvement in student academic performance following NLE implementation. However, the statistically significant differences were limited to first-generation university students and those entering directly from high school. We found considerable positive differences in all five performance measures in first-generation university students, with Year-1 GPA and cumulative GPA measurements exhibiting large effect sizes (Cohen’s r = 0.96 and 0.79, respectively, p < 0.005). Those entering from high school demonstrated significant differences in four of five performance measures, with the largest positive gains on the year-1 GPA (median before [n=765] and after [n=480]: 3.11– 3.30, 95% CI (0.09, 0.22), r=0.46, p < 0.005)). Second- and third-generation university students showed no significant differences, while nurse entrants exhibited a significant difference in their Y2GPA scores only with an actual drop in performance.Conclusion: The Ethiopian anesthetist NLE is associated with an overall modest in-school academic performance improvement, supporting its use. The stagnant or declining performance among nurse entrants and the newest (second and third) generation university students deserve further scrutiny.Keywords: anesthesia, anesthetist, associate clinician, non-physician, licensing examination

Published
2023

3. “I Got What I Came for”: A Qualitative Exploration into Family Planning Client Satisfaction in Dosso Region, Niger

Author

Calhoun LM, Maytan-Joneydi A, Nouhou AM, Benova L, Delvaux T, van den Akker T, Agali BI, and Speizer IS

Subjects
client satisfaction, family planning, contraception, niger, Gynecology and obstetrics, RG1-991
Abstract

Lisa M Calhoun,1– 3 Amelia Maytan-Joneydi,1 Abdoul Moumouni Nouhou,4 Lenka Benova,3 Thérèse Delvaux,3 Thomas van den Akker,2,5 Balki Ibrahim Agali,4 Ilene S Speizer1,6 1Carolina Population Center, the University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; 2Athena Institute, Vrije Universiteit, Amsterdam, Netherlands; 3Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium; 4GRADE Africa, Niamey, Niger; 5Department of Obstetrics and Gynaecology, Leiden University Medical Center, Leiden, Netherlands; 6Department of Maternal and Child Health, Gillings School of Global Public Health, the University of North Carolina at Chapel Hill, Chapel Hill, NC, USACorrespondence: Lisa M Calhoun, Carolina Population Center, the University of North Carolina at Chapel Hill, 123 West Franklin Street, Suite 210, Chapel Hill, NC, 27516, USA, Email lisa_calhoun@unc.eduBackground: Client satisfaction is recognized as an important construct for evaluating health service provision, yet the field of family planning (FP) lacks a standard approach to its measurement. Further, little is known about satisfaction with FP services in Niger, the site of this study. This study aims to understand what features of FP visits were satisfactory or dissatisfactory from a woman’s perspective and reflect on the conceptualization and measurement of satisfaction with FP services.Methods: Between February and March 2020, 2720 FP clients (ages 15– 49) were interviewed across 45 public health centers in Dosso region, Niger using a structured survey tool. The focus of this paper is on a random sub-sample of 100 clients who were additionally asked four open-ended questions regarding what they liked and disliked about their FP visit. Responses were audio-recorded, translated into French, transcribed, translated into English, coded, and analyzed thematically.Results: FP clients described nine key visit attributes related to their satisfaction with the visit: treatment by the provider, content of the counseling, wait time, FP commodity availability, privacy, cleanliness/infrastructure, visit processes and procedures, cost, and opening hours. The reason for FP visit (start, continue, or change method) was an important driver of the dimensions which contributed to satisfaction. Pre-formed expectations about the visit played a critical role in shaping satisfaction, particularly if the client’s pre-visit expectations (or negative expectations) were met or not and if she obtained what she came for.Conclusion: This study makes a significant contribution by identifying visit attributes that are important to FP clients in Dosso region, Niger, and highlights that satisfaction with FP services is shaped by more than just what occurs on the day of service. We propose a conceptual framework to understand satisfaction with FP services that can be used for future FP programming in Niger.Keywords: client satisfaction, family planning, contraception, Niger

Published
2022

4. Severe Hypertensive Disorders of Pregnancy in Eastern Ethiopia: Comparing the Original WHO and Adapted sub-Saharan African Maternal Near-Miss Criteria

Author

Tura AK, Scherjon S, Stekelenburg J, van Roosmalen J, van den Akker T, and Zwart J

Subjects
severe maternal outcomes, hypertensive disorders of pregnancy, maternal near miss, maternal mortality, sub-saharan africa, Gynecology and obstetrics, RG1-991
Abstract

Abera Kenay Tura,1,2 Sicco Scherjon,2 Jelle Stekelenburg,3,4 Jos van Roosmalen,5,6 Thomas van den Akker,5,6 Joost Zwart7 1School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia; 2Department of Obstetrics and Gynecology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands; 3Department of Health Sciences, Global Health, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands; 4Department of Obstetrics and Gynecology, Leeuwarden Medical Centre, Leeuwarden, The Netherlands; 5Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; 6Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands; 7Department of Obstetrics and Gynaecology, Deventer Ziekenhuis, Deventer, The NetherlandsCorrespondence: Abera Kenay TuraSchool of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, POB 235, Harar, EthiopaEmail a.k.tura@haramaya.edu.etObjectives: To assess life-threatening complications among women admitted with severe hypertensive disorders of pregnancy and compare applicability of World Health Organization (WHO) maternal near-miss (MNM) criteria and the recently adapted sub-Saharan African (SSA) MNM criteria in eastern Ethiopia.Methods: Of 1,054 women admitted with potentially life-threatening conditions between January 2016 and April 2017, 562 (53.3%) had severe preeclampsia/eclampsia. We applied the definition of MNM according to the WHO MNM criteria and the SSA MNM criteria. Logistic regression was performed to identify factors associated with severe maternal outcomes (MNMs and maternal deaths).Results: The SSA MNM criteria identified 285 cases of severe maternal outcomes: 271 MNMs and 14 maternal deaths (mortality index 4.9%). The WHO criteria identified 50 cases of severe maternal outcomes: 36 MNMs and 14 maternal deaths (mortality index 28%). The MNM ratio was 36.6 per 1,000 livebirths according to the SSA MNM criteria and 4.9 according to the WHO criteria. More than 80% of women in both groups had MNM events on arrival or within 12 hours after admission. Women without antenatal care, from rural areas, referred from other facilities, and with concomitant hemorrhage more often developed severe maternal outcomes.Conclusion: Regarding hypertensive disorders of pregnancy, the SSA tool is more inclusive than the WHO tool, while still maintaining a considerably high mortality index indicating severity of included cases. This may enable more robust audits. Strengthening the referral system and improving prevention and management of obstetric hemorrhage in women with hypertensive disorders of pregnancy are required to avert severe maternal outcomes.Keywords: severe maternal outcomes, hypertensive disorders of pregnancy, maternal near-miss, maternal mortality, sub-Saharan Africa

Published
2020

6. Effect of COVID-19 lockdown on maternity care and maternal outcome in the Netherlands: a national quasi-experimental study

Author

Ambrosino, E., Auweele, K.V., Been, J., Beijers, R., Bertens, L., Bloemenkamp, K., Boderie, N., Burdorf, L., Ochoa, L.B., de Jonge, A., de Weerth, C., Franx, A., Harper, S., Kazemier, B.M., Klein, P.P., Kretz, D., Labrecque, J., Mol, B.W., Muris, J., Nieuwenhuijze, M., Obermann, S., Oudijk, M., Peters, L., Ramerman, L., Ravelli, A., Schonewille-Rosman, A., Struijs, J., Torij, H., Van Beukering, M., van den Akker, T., van den Heuvel, M., van Dillen, J., van Lenthe, F., Van Ourti, T., Verhoeff, A., Vermeulen, M., Visser, N., Willers, S., Schoenmakers, S., Zainularab, Z., Gravesteijn, B.Y., Boderie, N.W., Bertens, L.C.M., Burgos Ochoa, L., Klein, P.P.F., Kwint-Reijnders, I., Labrecque, J.A., Obermann-Borst, S.A., Ravelli, A.C.J., Rosman, A., Been, J.V., and de Groot, C.J.

Published
2024
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17. Postpartum haemorrhage in high-resource settings:Variations in clinical management and future research directions based on a comparative study of national guidelines

Author

de Vries, P. L.M., Deneux-Tharaux, C., Baud, D., Chen, K. K., Donati, S., Goffinet, F., Knight, M., D’Souzah, R., Sueters, M., van den Akker, T., Athena Institute, Network Institute, and APH - Global Health

Subjects
clinical guidelines, postpartum haemorrhage, obstetric haemorrhage
Abstract

Objective: To compare guidelines from eight high-income countries on prevention and management of postpartum haemorrhage (PPH), with a particular focus on severe PPH. Design: Comparative study. Setting: High-resource countries. Population: Women with PPH. Methods: Systematic comparison of guidance on PPH from eight high-income countries. Main outcome measures: Definition of PPH, prophylactic management, measurement of blood loss, initial PPH-management, second-line uterotonics, non-pharmacological management, resuscitation/transfusion management, organisation of care, quality/methodological rigour. Conclusions: Our study highlights areas where strong evidence is lacking. There is need for a universal definition of (severe) PPH. Consensus is required on how and when to quantify blood loss to identify PPH promptly. Future research may focus on timing and sequence of second-line uterotonics and non-pharmacological interventions and how these impact maternal outcome. Until more data are available, different transfusion strategies will be applied. The use of clear transfusion-protocols are nonetheless recommended to reduce delays in initiation. There is a need for a collaborative effort to develop standardised, evidence-based PPH guidelines. Results: Definitions of (severe) PPH varied as to the applied cut-off of blood loss and incorporation of clinical parameters. Dose and mode of administration of prophylactic uterotonics and methods of blood loss measurement were heterogeneous. Recommendations on second-line uterotonics differed as to type and dose. Obstetric management diverged particularly regarding procedures for uterine atony. Recommendations on transfusion approaches varied with different thresholds for blood transfusion and supplementation of haemostatic agents. Quality of guidelines varied considerably.

Published
2023

19. Binational confidential enquiry of maternal deaths due to postpartum hemorrhage in France and the Netherlands: Lessons learned through the perspective of a different context of care

Author

MS Verloskunde, Child Health, de Vries, P L M, van den Akker, T, Bloemenkamp, K W M, Grossetti, E, Rigouzzo, A, Saucedo, M, Verspyck, E, Zwart, J, Deneux-Tharaux, C, MS Verloskunde, Child Health, de Vries, P L M, van den Akker, T, Bloemenkamp, K W M, Grossetti, E, Rigouzzo, A, Saucedo, M, Verspyck, E, Zwart, J, and Deneux-Tharaux, C

Published
2023

20. Every maternal near-miss counts: Need for a national audit in South Africa?: A mixed-methods study

Author

Heitkamp, A., Suh, J., Gebhardt, S., van Roosmalen, J., Murray, L. R., de Vries, J. I., van den Akker, T., Theron, G., Athena Institute, Human Movement Sciences, Network Institute, APH - Global Health, Obstetrics and gynaecology, Ethics, Law & Medical humanities, APH - Quality of Care, AMS - Rehabilitation & Development, Amsterdam Reproduction & Development (AR&D), and VU University medical center

Subjects
Pregnancy Complications, South Africa, Maternal Mortality, SDG 3 - Good Health and Well-being, Pregnancy, Maternal Death, Near Miss, Healthcare, Humans, Female, Maternal Health Services, General Medicine
Abstract

Background. To improve maternal health, studies of maternal morbidity are increasingly being used to evaluate the quality of maternity care, in addition to studies of mortality. While South Africa (SA) has a well-established confidential enquiry into maternal deaths, there is currently no structure in place to systematically collect and analyse maternal near-misses (MNMs) at national level.Objectives. To synthesise MNM indicators and causes in SA by performing a systematic literature search, and to investigate perceived needs for data collection related to MNMs and determine whether the MNM tool from the World Health Organization (WHO-MNM) would require adaptations in order to be implemented.Methods. The study used a mixed-methods approach. A systematic literature search was conducted to find all published data on MNM audits in SA. Semi-structured interviews were conducted virtually with maternal health experts throughout the country who had been involved in studies of MNMs, and main themes arising in the interviews were synthesised. A method for MNM data collection for SA use was discussed with these experts.Results. The literature search yielded 797 articles, 15 of which met the WHO-MNM or Mantel et al. severe acute maternal morbidity criteria. The median (interquartile range) MNM incidence ratio in SA was 8.4/1 000 (5.6 - 8.7) live births, the median maternal mortality ratio was 130/100 000 (71.4 - 226) live births, and the median mortality index was 16.6% (11.7 - 18.8). The main causes of MNMs were hypertensive disorders of pregnancy and obstetric haemorrhage. Eight maternal health experts were interviewed from May 2020 to February 2021. All participants focused on the challenges of implementing a national MNM audit, yet noted the urgent need for one. Recognition of MNMs as an indicator of quality of maternity care was considered to lead to improved management earlier in the chain of events, thereby possibly preventing mortality. Obtaining qualitative information from women with MNMs was perceived as an important opportunity to improve the maternity care system. Participants suggested that the WHO-MNM tool would have to be adapted into a simplified tool with more clearly defined criteria and a number of specific diagnoses relevant to the SA setting. This ‘Maternal near-miss: Inclusion criteria and data collection form’ is provided as a supplementary file.Conclusion. Adding MNMs to the existing confidential maternal death enquiry could potentially contribute to a more robust audit with data that may inform health systems planning. This was perceived by SA experts to be valuable, but would require context-specific adaptations to the WHO-MNM tool. The available body of evidence is sufficient to justify moving to implementation.

Published
2022

22. Evaluating Clinical Outcomes and Physiological Perspectives in Studies Investigating Respiratory Support for Babies Born at Term With or at Risk of Transient Tachypnea: A Narrative Review.

Author

McGillick, EV, Te Pas, AB, van den Akker, T, Keus, JMH, Thio, M, Hooper, SB, McGillick, EV, Te Pas, AB, van den Akker, T, Keus, JMH, Thio, M, and Hooper, SB

Abstract

Respiratory distress in the first few hours of life is a growing disease burden in otherwise healthy babies born at term (>37 weeks gestation). Babies born by cesarean section without labor (i.e., elective cesarean section) are at greater risk of developing respiratory distress due to elevated airway liquid volumes at birth. These babies are commonly diagnosed with transient tachypnea of the newborn (TTN) and historically treatments have mostly focused on enhancing airway liquid clearance pharmacologically or restricting fluid intake with limited success. Alternatively, a number of clinical studies have investigated the potential benefits of respiratory support in newborns with or at risk of TTN, but there is considerable heterogeneity in study designs and outcome measures. A literature search identified eight clinical studies investigating use of respiratory support on outcomes related to TTN in babies born at term. Study demographics including gestational age, mode of birth, antenatal corticosteroid exposure, TTN diagnosis, timing of intervention (prophylactic/interventional), respiratory support (type/interface/device/pressure), and study outcomes were compared. This narrative review provides an overview of factors within and between studies assessing respiratory support for preventing and/or treating TTN. In addition, we discuss the physiological understanding of how respiratory support aids lung function in newborns with elevated airway liquid volumes at birth. However, many questions remain regarding the timing of onset, pressure delivered, device/interface used and duration, and weaning of support. Future studies are required to address these gaps in knowledge to provide evidenced based recommendations for management of newborns with or at risk of TTN.

Published
2022

23. Confidential enquiry into maternal deaths in the Netherlands, 2006–2018

Author

Kallianidis, A. F., Schutte, J. M., Schuringa, L. E. M., Beenakkers, I. C. M., Bloemenkamp, K. W. M., Braams-Lisman, B. A. M., Cornette, J., Kuppens, S. M., Rietveld, A. L., Schaap, T., Stekelenburg, J., Zwart, J. J., van den Akker, T., Kallianidis, A. F., Schutte, J. M., Schuringa, L. E. M., Beenakkers, I. C. M., Bloemenkamp, K. W. M., Braams-Lisman, B. A. M., Cornette, J., Kuppens, S. M., Rietveld, A. L., Schaap, T., Stekelenburg, J., Zwart, J. J., and van den Akker, T.

Abstract

Introduction: To calculate the maternal mortality ratio (MMR) for 2006–2018 in the Netherlands and compare this with 1993–2005, and to describe women’s characteristics, causes of death and improvable factors. Material and Methods: We performed a nationwide, cohort study of all maternal deaths between January 1, 2006 and December 31, 2018 reported to the Audit Committee Maternal Mortality and Morbidity. Main outcome measures were the national MMR and causes of death. Results: Overall MMR was 6.2 per 100 000 live births, a decrease from 12.1 in 1993–2005 (risk ratio [RR] 0.5). Women with a non-western ethnic background had an increased MMR compared with Dutch women (MMR 6.5 vs. 5.0, RR 1.3). The MMR was increased among women with a background from Surinam/Dutch Antilles (MMR 14.7, RR 2.9). Half of all women had an uncomplicated medical history (79/161, 49.1%). Of 171 pregnancy-related deaths within 1 year postpartum, 102 (60%) had a direct and 69 (40%) an indirect cause of death. Leading causes within 42 days postpartum were cardiac disease (n = 21, 14.9%), hypertensive disorders (n = 20, 14.2%) and thrombosis (n = 19, 13.5%). Up to 1 year postpartum, the most common cause of death was cardiac disease (n = 32, 18.7%). Improvable care factors were identified in 76 (47.5%) of all deaths. Conclusions: Maternal mortality halved in 2006–2018 compared with 1993–2005. Cardiac disease became the main cause. In almost half of all deaths, improvable factors were identified and women with a background from Surinam/Dutch Antilles had a threefold increased risk of death compared with Dutch women without a background of migration.

Published
2022

25. SARS-CoV-2 infection in pregnancy during the first wave of COVID-19 in the Netherlands: a prospective nationwide population-based cohort study (NethOSS)

Author

MS Verloskunde, Geboortecentrum voorzitterschap, Child Health, Overtoom, E. M., Rosman, A. N., Zwart, J. J., Vogelvang, T. E., Schaap, T. P., van den Akker, T., Bloemenkamp, K. W.M., MS Verloskunde, Geboortecentrum voorzitterschap, Child Health, Overtoom, E. M., Rosman, A. N., Zwart, J. J., Vogelvang, T. E., Schaap, T. P., van den Akker, T., and Bloemenkamp, K. W.M.

Published
2022

27. Effect of breathing on venous return during delayed cord clamping: An observational study.

Author

Brouwer E., Knol R., Kroushev A., Van Den Akker T., Hooper S.B., Roest A.A., Te Pas A.B., Brouwer E., Knol R., Kroushev A., Van Den Akker T., Hooper S.B., Roest A.A., and Te Pas A.B.

Abstract

Objective: To investigate the effect of spontaneous breathing on venous return in term infants during delayed cord clamping at birth. Method(s): Echocardiographic ultrasound recordings were obtained directly after birth in healthy term-born infants. A subcostal view was used to obtain an optimal view of the inferior vena cava (IVC) entering the right atrium, including both the ductus venosus (DV) and the hepatic vein (HV). Colour Doppler was used to assess flow direction and flow velocity. Recordings continued until the umbilical cord was clamped and were stored in digital format for offline analyses. Result(s): Ultrasound recordings were obtained in 15 infants, with a median (IQR) gestational age of 39.6 (39.0-40.9) weeks and a birth weight of 3560 (3195-4205) g. Flow was observed to be antegrade in the DV and HV in 98% and 82% of inspirations, respectively, with flow velocity increasing in 74% of inspirations. Retrograde flow in the DV was observed sporadically and only occurred during expiration. Collapse of the IVC occurred during 58% of inspirations and all occurred caudal to the DV inlet (100%). Conclusion(s): Spontaneous breathing was associated with collapse of the IVC and increased antegrade DV and HV flow velocity during inspiration. Therefore, inspiration appears to preferentially direct blood flow from the DV into the right atrium. This indicates that inspiration could be a factor driving placental transfusion in infants. Copyright © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Published
2021

28. Trends in population health and demography

Author

Maaløe, N., Housseine, N., Meguid, T., Tellier, S., van Roosmalen, J., Meyrowitsch, D.W., van den Akker, T., Maaløe, N., Housseine, N., Meguid, T., Tellier, S., van Roosmalen, J., Meyrowitsch, D.W., and van den Akker, T.

Published
2021
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31. A total blood volume or more transfused during pregnancy or after childbirth: Individual patient data from six international population-based observational studies.

Author

McCall, SJ, Henriquez, D, Edwards, HM, van den Akker, T, Bloemenkamp, KWM, van der Bom, J, Bonnet, M-P, Deneux-Tharaux, C, Donati, S, Gillissen, A, Kurinczuk, JJ, Li, Z, Maraschini, A, Seco, A, Sullivan, E, Stanworth, S, Knight, M, McCall, SJ, Henriquez, D, Edwards, HM, van den Akker, T, Bloemenkamp, KWM, van der Bom, J, Bonnet, M-P, Deneux-Tharaux, C, Donati, S, Gillissen, A, Kurinczuk, JJ, Li, Z, Maraschini, A, Seco, A, Sullivan, E, Stanworth, S, and Knight, M

Abstract

Background

This study aimed to compare incidence, management and outcomes of women transfused their blood volume or more within 24 hours during pregnancy or following childbirth.

Methods

Combined analysis of individual patient data, prospectively collected in six international population-based studies (France, United Kingdom, Italy, Australia, the Netherlands and Denmark). Massive transfusion in major obstetric haemorrhage was defined as transfusion of eight or more units of red blood cells within 24 hours in a pregnant or postpartum woman. Causes, management and outcomes of women with massive transfusion were compared across countries using descriptive statistics.

Findings

The incidence of massive transfusion was approximately 21 women per 100,000 maternities for the United Kingdom, Australia and Italy; by contrast Denmark, the Netherlands and France had incidences of 82, 66 and 69 per 100,000 maternities, respectively. There was large variation in obstetric and haematological management across countries. Fibrinogen products were used in 86% of women in Australia, while the Netherlands and Italy reported lower use at 35-37% of women. Tranexamic acid was used in 75% of women in the Netherlands, but in less than half of women in the UK, Australia and Italy. In all countries, women received large quantities of colloid/crystalloid fluids during resuscitation (>3·5 litres). There was large variation in the use of compression sutures, embolisation and hysterectomy across countries. There was no difference in maternal mortality; however, variable proportions of women had cardiac arrests, renal failure and thrombotic events from 0-16%.

Interpretation

There was considerable variation in the incidence of massive transfusion associated with major obstetric haemorrhage across six high-income countries. There were also large disparities in both transfusion and obstetric management between these countries. There is a requirement for detailed evaluati

Published
2021

35. Epidemiological analysis of peripartum hysterectomy across 9 European countries

Author

Kallianidis, AF, Maraschini, A, Danis, J, Colmorn, LB, Deneux-Tharaux, C, Donati, S, Gissler, M, Jakobsson, M, Knight, M, Kristufkova, A, Lindqvist, PG, Vandenberghe, G, Van Den Akker, T, and Systems), INOSS (the International Network of Obstetric Survey

Abstract

Introduction Peripartum hysterectomy is a surgical procedure performed for severe obstetric complications such as major obstetric hemorrhage. The prevalence of peripartum hysterectomy in high‐resource settings is relatively low. Hence, international comparisons and studying indications and associations with mode of birth rely on the use of national obstetric survey data. Objectives were to calculate the prevalence and indications of peripartum hysterectomy and its association with national cesarean section rates and mode of birth in nine European countries. Material and methods We performed a descriptive, multinational, population‐based study among women who underwent peripartum hysterectomy. Data were collected from national or multiregional databases from nine countries participating in the International Network of Obstetric Survey Systems. We included hysterectomies performed from 22 gestational weeks up to 48 hours postpartum for obstetric hemorrhage, as this was the most restrictive, overlapping case definition between all countries. Main outcomes were prevalence and indications of peripartum hysterectomy. Additionally, we compared prevalence of peripartum hysterectomy between women giving birth vaginally and by cesarean section, and between women giving birth with and without previous cesarean section. Finally, we calculated correlation between prevalence of peripartum hysterectomy and national cesarean section rates, as well as national rates of women giving birth after a previous cesarean section. Results A total of 1302 peripartum hysterectomies were performed in 2 498 013 births, leading to a prevalence of 5.2 per 10 000 births ranging from 2.6 in Denmark to 10.7 in Italy. Main indications were uterine atony (35.3%) and abnormally invasive placenta (34.8%). Relative risk of hysterectomy after cesarean section compared with vaginal birth was 9.1 (95% CI 8.0‐10.4). Relative risk for hysterectomy for birth after previous cesarean section compared with birth without previous cesarean section was 10.6 (95% CI 9.4‐12.1). A strong correlation was observed between national cesarean section rate and prevalence of peripartum hysterectomy (ρ = 0.67, P < .05). Conclusions Prevalence of peripartum hysterectomy may vary considerably between high‐income countries. Uterine atony and abnormally invasive placenta are the commonest indications for hysterectomy. Birth by cesarean section and birth after previous cesarean section are associated with nine‐fold increased risk of peripartum hysterectomy.

Published
2020

36. Physiological-based cord clamping in very preterm infants — Randomised controlled trial on effectiveness of stabilisation

Author

Knol, R. (Ronny), Brouwer, E. (Emma), van den Akker, T. (Thomas), DeKoninck, P. (Philip), Geloven, N. (Nan) van, Polglase, G.R. (Graeme R.), Lopriore, E., Herkert, E. (Ellen), Reiss, I.K.M. (Irwin), Hooper, S.B. (Stuart B.), Te Pas, A.B. (Arjan B.), Knol, R. (Ronny), Brouwer, E. (Emma), van den Akker, T. (Thomas), DeKoninck, P. (Philip), Geloven, N. (Nan) van, Polglase, G.R. (Graeme R.), Lopriore, E., Herkert, E. (Ellen), Reiss, I.K.M. (Irwin), Hooper, S.B. (Stuart B.), and Te Pas, A.B. (Arjan B.)

Abstract

Aim: To test whether stabilising very preterm infants while performing physiological-based cord clamping (PBCC) is at least as effective as the standard approach of time-based delayed cord clamping (DCC). Methods: A randomised contro

Published
2020
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37. Socioeconomic differences in caesarean section - Are they explained by medical need? An analysis of patient record data of a large Kenyan hospital

Author

Van Der Spek, L. (Lisa), Sanglier, S. (Sterre), Mabeya, H.M. (Hillary M.), Van Den Akker, T. (Thomas), Mertens, P.L.J.M. (Paul L. J. M.), Houweling, A.J. (Tanja), Van Der Spek, L. (Lisa), Sanglier, S. (Sterre), Mabeya, H.M. (Hillary M.), Van Den Akker, T. (Thomas), Mertens, P.L.J.M. (Paul L. J. M.), and Houweling, A.J. (Tanja)

Abstract

Background: Caesarean section (C-section) rates are often low among the poor and very high among the better-off in low- and middle-income countries. We examined to what extent these differences are explained by medical need in an African context. Methods: We analyzed electronic records of 12,209 women who gave birth in a teaching hospital in Kenya in 2014. C-section rates were calculated by socioeconomic position (SEP), using maternal occupation (professional, small business, housewife, student) as indicator. We assessed if women had documented clinical indications according to hospital guidelines and if socioeconomic differences in C-section rates were explained by indication. Results: Indication for C-section according to hospital guidelines was more prevalent among professionals than housewives (16% vs. 9% of all births). The C-section rate was also higher among professionals than housewives (21.1% vs. 15.8% [OR 1.43; 95%CI 1.23-1.65]). This C-section rate difference was largely explained by indication (4.7 of the 5.3 percentage point difference between professionals and housewives concerned indicated C-sections, often with previous C-section as indication). Repeat C-sections were near-universal (99%). 43% of primary C-sections had no documented indication. Over-use was somewhat higher among professionals than housewives (C-section rate among women without indication: 6.6 and 5.5% respectively), which partly explained socioeconomic differences in primary C-section rate. Conclusions: Socioeconomic differences in C-section rates can be largely explained by unnecessary primary C-sections and higher supposed need due to previous C-section. Prevention of unnecessary primary C-sections and promoting safe trial of labor should be priorities in addressing C-section over-use and reducing inequalities. Tweetable abstract: Unnecessary primary C-sections and ubiquitous repeat C-sections drive overall C-section rates and C-section inequalities.

Published
2020
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41. SARS‐CoV‐2 infection in pregnancy during the first wave of COVID‐19 in the Netherlands: a prospective nationwide population‐based cohort study (NethOSS).

Author

Overtoom, EM, Rosman, AN, Zwart, JJ, Vogelvang, TE, Schaap, TP, van den Akker, T, and Bloemenkamp, KWM

Subjects
WOMEN'S hospitals, SARS-CoV-2, COVID-19, PREGNANT women, CESAREAN section, INTENSIVE care units
Abstract

Objective: To describe characteristics, risk factors and maternal, obstetric and neonatal outcomes of pregnant women infected with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). Design: Multi‐centre prospective population‐based cohort study. Setting: Nationwide study in the Netherlands. Population: Pregnant women with confirmed SARS‐CoV‐2 infection admitted to hospital or in home‐isolation: 1 March 2020 to 31 August 2020. Methods: Pregnant women with positive polymerase chain reaction or antibody tests were registered using the Netherlands Obstetrics Surveillance System (NethOSS). (Selective) testing occurred according to national guidelines. Data from the national birth registry (pregnant pre‐coronavirus disease 2019 [COVID‐19] cohort) and an age‐matched cohort of COVID‐19‐positive women (National Institute for Public Health and the Environment; fertile age COVID‐19 cohort) were used as reference. Main outcome measures: Incidence of SARS‐CoV‐2 infection in pregnant women. Maternal, obstetric and neonatal outcomes including hospital and intensive care admission. Results: Of 376 registered pregnant women with confirmed SARS‐CoV‐2 infection, 20% (74/376) were admitted to hospital, of whom 84% (62/74) were due to SARS‐CoV‐2; 10% (6/62) were admitted to intensive care and 15% (9/62) to obstetric high‐care units. Risk factors for admission were non‐European country of origin (odds ratio [OR] 1.73, 95% CI 1.01–2.96) and being overweight/obese (OR 1.86, 95% CI 1.51–3.20). No maternal or perinatal deaths occurred. Caesarean section after labour‐onset was increased (OR 1.58, 95% CI 1.09–2.28). Hospital and intensive care admission were higher compared with the fertile age COVID‐19 cohort (OR 6.75, 95% CI 5.18–8.81 and OR 2.52, 95% CI 1.11–5.77, respectively). Conclusions: Non‐European country of origin and being overweight/obese are risk factors for severe course of SARS‐CoV‐2 infection in pregnancy, risk of caesarean section and hospital and intensive care unit admission are increased. Pregnant women with SARS‐CoV‐2 in the Netherlands show increased hospital/ICU admission and caesarean section. Pregnant women with SARS‐CoV‐2 in the Netherlands show increased hospital/ICU admission and caesarean section. This article includes Author Insights, a video abstract available at: https://vimeo.com/bjog/authorinsights16903 [ABSTRACT FROM AUTHOR]

Published
2022
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42. Clinical characteristics of women captured by extending the definition of severe postpartum haemorrhage with 'refractoriness to treatment': a cohort study

Author

Henriquez, D., Gillissen, A., Smith, S.M., Cramer, R.A., van den Akker, T., Zwart, J.J. (Joost), van Roosmalen, J.J., Bloemenkamp, KW, Bom, J.G., Adriaanse, H.J., van den Akker, E.S.A., Baas, M.I., Bank, C.M.C., Beek, E. van, de Boer, B.A.G., Boer, K. (Karin), van der Borden, D.M.R., Bremer, H.A. (Henk), Brons, J.T.J., Burggraaff, J.M. (Jan), Ceelie, H., Chon, H., Cikot, J.L.M., Delemarre, F.M.C., Diris, J.H.C., Doesburg-van Kleffens, M., van Dooren, I.M.A., van Duijnhoven, J.L.P., van Dunn, F.M., Duvekot, J.J. (Hans), Engbers, P., van Hulst, M.J.W., Feitsma, H., Fouraux, M.A., Franssen, MT, Frasa, M.A.M., van Gammeren, A.J., Gemund, N. (Nicolette) van, van der Graaf, F., Groot, C.J.M., Hackeng, C.M. (Christian), Ham, D.P. (David) van der, Hanssen, M., Hasaart, T.H.M. (Tom), Hendriks, H.A., Henskens, Y.M.C., Hermsen, B.B.J., Hogenboom, S., Hooker, A., Hudig, F, Huijssoon, A.G. (Annemarie), Huisjes, A.J.M. (Anjoke), Jonker, N., Kabel, P.J., van Kampen, C., de Keijzer, M.H., van de Kerkhof, D.H., Keuren, JFW, Kleiverda, G., Klinkspoor, J.H., Koehorst, S.G.A., Kok, M.O. (Maarten), Kok, R.D., Kok, J.B. (Jacques) de, Koops, A., Kortlandt, W. (Wouter), Langenveld, J. (J.), Leers, MPG, Leyte, A. (Anja), de Mare, A., Martens, G.D.M., Meekers, J.H., Meir, C.A. (Claudia) van, Metz, G.C.H. (Godfried), Michielse, E., Mostert, L.J., Bijvank, S., Oostenveld, E., Osmanovic, N., Oudijk, M.A. (Martijn), Mirani-Oostdijk, C.P., van Pampus, E. C. M., Papatsonis, D.N.M. (Dimitri), Peters, R.H.M., Ponjee, G.A.E. (Gabriëlle), Pontesilli, M., Porath, M. (Martina), Post, M.S., Pouwels, J.G.J., Prinzen, L., Roelofsen, J.M.T., Rondeel, J.J.M., Salm, P.C.M. (Paulien) van der, Scheepers, H.C.J. (Hubertina), Schippers, D.H. (Daniela), Schuitemaker, N.W.E. (Nico), Sikkema, J.M. (J. Marko), Slomp, J. (Jennita), Smit, J.W.A. (Jan), Snuif-de Lange, Y.S., van der Stappen, J.W.J., Steures, P. (Pieternel), Tax, G.H.M., Treskes, M., Ulenkate, H., van Unnik, G.A., van der Veen, B.S., Verhagen, T.E.M., Versendaal, J. (Johan), Visschers, B., Visser, O. (Oane), de Visser, H., De Vooght, KMK, de Vries, M.J., Waard, H. (Harm) de, Weerkamp, F. (Floor), Weinans, M.J.N. (Martin), de Wet, H., Wijnen, M. (Marit), Wijngaarden, W.J. (Wim) van, de Wit, A.C., Woiski, M.D. (Mallory), TeMp, O.H.S.G., Henriquez, D., Gillissen, A., Smith, S.M., Cramer, R.A., van den Akker, T., Zwart, J.J. (Joost), van Roosmalen, J.J., Bloemenkamp, KW, Bom, J.G., Adriaanse, H.J., van den Akker, E.S.A., Baas, M.I., Bank, C.M.C., Beek, E. van, de Boer, B.A.G., Boer, K. (Karin), van der Borden, D.M.R., Bremer, H.A. (Henk), Brons, J.T.J., Burggraaff, J.M. (Jan), Ceelie, H., Chon, H., Cikot, J.L.M., Delemarre, F.M.C., Diris, J.H.C., Doesburg-van Kleffens, M., van Dooren, I.M.A., van Duijnhoven, J.L.P., van Dunn, F.M., Duvekot, J.J. (Hans), Engbers, P., van Hulst, M.J.W., Feitsma, H., Fouraux, M.A., Franssen, MT, Frasa, M.A.M., van Gammeren, A.J., Gemund, N. (Nicolette) van, van der Graaf, F., Groot, C.J.M., Hackeng, C.M. (Christian), Ham, D.P. (David) van der, Hanssen, M., Hasaart, T.H.M. (Tom), Hendriks, H.A., Henskens, Y.M.C., Hermsen, B.B.J., Hogenboom, S., Hooker, A., Hudig, F, Huijssoon, A.G. (Annemarie), Huisjes, A.J.M. (Anjoke), Jonker, N., Kabel, P.J., van Kampen, C., de Keijzer, M.H., van de Kerkhof, D.H., Keuren, JFW, Kleiverda, G., Klinkspoor, J.H., Koehorst, S.G.A., Kok, M.O. (Maarten), Kok, R.D., Kok, J.B. (Jacques) de, Koops, A., Kortlandt, W. (Wouter), Langenveld, J. (J.), Leers, MPG, Leyte, A. (Anja), de Mare, A., Martens, G.D.M., Meekers, J.H., Meir, C.A. (Claudia) van, Metz, G.C.H. (Godfried), Michielse, E., Mostert, L.J., Bijvank, S., Oostenveld, E., Osmanovic, N., Oudijk, M.A. (Martijn), Mirani-Oostdijk, C.P., van Pampus, E. C. M., Papatsonis, D.N.M. (Dimitri), Peters, R.H.M., Ponjee, G.A.E. (Gabriëlle), Pontesilli, M., Porath, M. (Martina), Post, M.S., Pouwels, J.G.J., Prinzen, L., Roelofsen, J.M.T., Rondeel, J.J.M., Salm, P.C.M. (Paulien) van der, Scheepers, H.C.J. (Hubertina), Schippers, D.H. (Daniela), Schuitemaker, N.W.E. (Nico), Sikkema, J.M. (J. Marko), Slomp, J. (Jennita), Smit, J.W.A. (Jan), Snuif-de Lange, Y.S., van der Stappen, J.W.J., Steures, P. (Pieternel), Tax, G.H.M., Treskes, M., Ulenkate, H., van Unnik, G.A., van der Veen, B.S., Verhagen, T.E.M., Versendaal, J. (Johan), Visschers, B., Visser, O. (Oane), de Visser, H., De Vooght, KMK, de Vries, M.J., Waard, H. (Harm) de, Weerkamp, F. (Floor), Weinans, M.J.N. (Martin), de Wet, H., Wijnen, M. (Marit), Wijngaarden, W.J. (Wim) van, de Wit, A.C., Woiski, M.D. (Mallory), and TeMp, O.H.S.G.

Abstract

Background: The absence of a uniform and clinically relevant definition of severe postpartum haemorrhage hampers comparative studies and optimization of clinical management. The concept of persistent postpartum haemorrhage, based on refractoriness to initial first-line treatment, was proposed as an alternative to common definitions that are either based on estimations of blood loss or transfused units of packed red blood cells (RBC). We compared characteristics and outcomes of women with severe postpartum haemorrhage captured by these three types of definitions. Methods: In this large retrospective cohort study in 61 hospitals in the Netherlands we included 1391 consecutive women with postpartum haemorrhage who received either ≥4 units of RBC or a multicomponent transfusion. Clinical characteristics and outcomes of women with severe postpartum haemorrhage defined as persistent postpartum haemorrhage were compared to definitions based on estimated blood loss or transfused units of RBC within 24 h following birth. Adverse maternal outcome was a composite of maternal mortality, hysterectomy, arterial embolisation and intensive care unit admission. Results: One thousand two hundred sixty out of 1391 women (90.6%) with postpartum haemorrhage fulfilled the definition of persistent postpartum haemorrhage. The majority, 820/1260 (65.1%), fulfilled this definition within 1 h following birth, compared to 819/1391 (58.7%) applying the definition of ≥1 L blood loss and 37/845 (4.4%) applying the definition of ≥4 units of RBC. The definition persistent postpartum haemorrhage captured 430/471 adverse maternal outcomes (91.3%), compared to 471/471 (100%) for ≥1 L blood loss and 383/471 (81.3%) for ≥4 units of RBC. Persiste

Published
2019
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43. Effectiveness of Stabilization of Preterm Infants With Intact Umbilical Cord Using a Purpose-Built Resuscitation Table-Study Protocol for a Randomized Controlled Trial

Author

Knol, R., Brouwer, E. (Eric), Klumper, F., van den Akker, T., DeKoninck, P, Hutten, G.J., Lopriore, E., van Kaam, AH, Polglase, G.R., Reiss, I.K.M. (Irwin), Hooper, S.B., te Pas, A.B., Knol, R., Brouwer, E. (Eric), Klumper, F., van den Akker, T., DeKoninck, P, Hutten, G.J., Lopriore, E., van Kaam, AH, Polglase, G.R., Reiss, I.K.M. (Irwin), Hooper, S.B., and te Pas, A.B.

Abstract

Background: Most preterm infants fail to aerate their immature lungs at birth and need respiratory support for cardiopulmonary stabilization. Cord clamping before lung aeration compromises cardiovascular function. Delaying cord clamping until the lung has aerated may be beneficial for preterm infants by optimizing hemodynamic transition and placental transfusion. A new purpose-built resuscitation table (the Concord) has been designed making it possible to keep the cord intact after preterm birth until the lung is aerated and the infant is respiratory stable and breathing [Physiological-Based Cord Clamping (PBCC)]. The aim of this study is to test the hypothesis whether stabilizing preterm infants by PBCC is at least as effective as the standard approach using time-based Delayed Cord Clamping (DCC). Study design: This is a randomized controlled non-inferiority study including 64 preterm infants born at <32 weeks of gestation. Infants will be randomized to either the PBCC approach or standard DCC. In case of PBCC, infants will be stabilized with an intact umbilical cord and the cord will only be clamped when the infant is considered respiratory stable, defined as the establishment of regular spontaneous breathing, a heart rate ≥100 bpm and oxygen saturation above 90% while using inspired fraction of oxygen (FiO2) < 0.40. The Concord will be used, which allows giving respiratory support with an intact umbilical cord. In the DCC group infants are clamped first before they are transferred to the standard resuscitation table for further treatment and stabilization. Cord clamping is time-based and delayed at 30–60 s. The primary outcome will be the time to respiratory stability of the infant, starting from birth. Secondary outcomes will include details of stabilization, important clinical outcomes of prematurity and maternal safety outcomes. Discussion: We expect that PBCC using the Concord may reduce major morbidities and mortality in preterm infants. The current study pr

Published
2019
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44. Defining definitions: a Delphi study to develop a core outcome set for conditions of severe maternal morbidity

Author

Schaap, T, Bloemenkamp, K, Deneux-Tharaux, Cairns, Knight, Megan, Langhoff-Roos, J., Sullivan, Elizabeth, van den Akker, T, Rigouzzo, Agnes, Univ, Comenius, Creanga, Andreea, Koopman, Ankie, Franx, Arie, Nemethova, Bianka, Bateman, Brian, Daelemans, Caroline, Zelop, Carolyn, Medicine, Boston University School, Nagata, Chie, Farquhar, Cindy M., Huisman, Claartje, von Kaisenberg, Constantin, Henruquez, Dacia, Ellwood, David, Moolenaar, David, Kuklina, Elena, Main, Elliott, Stekkinger, Eva, Gollo, Evelina, Goffinet, Francois, Kainer, Franz, Africa, University of Pretoria Kalafong Academic Hospital, Stralen, Giel, Kayem, Gilles, Duvekot, Hans, Franz, Heiko B G, Engjom, Hilde, Beenakkers, Ingrid, Al-Zirqi, Iqbal, Danis, Jakub, Berlac, Foss, UK, Leicester Royal, Parsonage, Will, Zwart, Joost, van Roosmalen, Jos, Klungsor, Kari, Lust, Karin, Vetter, Klaus, Calsteren, Kristel, Roelens, Kristien, Krebs, Lone, Colmorn, Berdiin, Tanaka, Mamoru, Rijken, Marcus, Bonnet, Marie-Pierre, Boer, Marjon, Jokinen, Mervi, Belfort, Michael, Peek, Michael, Gisler, Mika, Foley, Mike, Tikkanen, Minna, Korbel, Miroslav, laubach, Monika, Schuitemaker, Nico, Engel, Nicole, McDonnell, Nolan, Emonts, Patrick, Rozenberg, Patrick, Hillemanns, Peter, Rauskolb, Rudiger, Takeda, Satoru, Donati, Serena, Ferrazzani, Sergio, Saito, Shigeru, Jesudason, Shilpanjali, Satoh, Shoji, Health, Norwegian Institute of, Clark, Steven, Koenen, Steven, Grussner, Susanne, Miyashita, Susumu, Fischer, Thorsten, Todros, Tullia, Mijatovic, Veljia, Basevi, Vittorio, Pollock, Wendy, Callaghan, William, Henrich, Wolfgang, Fujita, Yasuyuki, Matsuda, Yoshio, Garnier, Yves, Zentner, Dominica, other, and, Schaap, T, Bloemenkamp, K, Deneux-Tharaux, Cairns, Knight, Megan, Langhoff-Roos, J., Sullivan, Elizabeth, van den Akker, T, Rigouzzo, Agnes, Univ, Comenius, Creanga, Andreea, Koopman, Ankie, Franx, Arie, Nemethova, Bianka, Bateman, Brian, Daelemans, Caroline, Zelop, Carolyn, Medicine, Boston University School, Nagata, Chie, Farquhar, Cindy M., Huisman, Claartje, von Kaisenberg, Constantin, Henruquez, Dacia, Ellwood, David, Moolenaar, David, Kuklina, Elena, Main, Elliott, Stekkinger, Eva, Gollo, Evelina, Goffinet, Francois, Kainer, Franz, Africa, University of Pretoria Kalafong Academic Hospital, Stralen, Giel, Kayem, Gilles, Duvekot, Hans, Franz, Heiko B G, Engjom, Hilde, Beenakkers, Ingrid, Al-Zirqi, Iqbal, Danis, Jakub, Berlac, Foss, UK, Leicester Royal, Parsonage, Will, Zwart, Joost, van Roosmalen, Jos, Klungsor, Kari, Lust, Karin, Vetter, Klaus, Calsteren, Kristel, Roelens, Kristien, Krebs, Lone, Colmorn, Berdiin, Tanaka, Mamoru, Rijken, Marcus, Bonnet, Marie-Pierre, Boer, Marjon, Jokinen, Mervi, Belfort, Michael, Peek, Michael, Gisler, Mika, Foley, Mike, Tikkanen, Minna, Korbel, Miroslav, laubach, Monika, Schuitemaker, Nico, Engel, Nicole, McDonnell, Nolan, Emonts, Patrick, Rozenberg, Patrick, Hillemanns, Peter, Rauskolb, Rudiger, Takeda, Satoru, Donati, Serena, Ferrazzani, Sergio, Saito, Shigeru, Jesudason, Shilpanjali, Satoh, Shoji, Health, Norwegian Institute of, Clark, Steven, Koenen, Steven, Grussner, Susanne, Miyashita, Susumu, Fischer, Thorsten, Todros, Tullia, Mijatovic, Veljia, Basevi, Vittorio, Pollock, Wendy, Callaghan, William, Henrich, Wolfgang, Fujita, Yasuyuki, Matsuda, Yoshio, Garnier, Yves, Zentner, Dominica, and other, and

Abstract

Objective: Develop a core outcome set of international consensus definitions for severe maternal morbidities. Design: Electronic Delphi study. Setting: International. Population: Eight expert panels. Methods: All 13 high-income countries represented in the International Network of Obstetric Surveillance Systems (INOSS) nominated five experts per condition of morbidity, who submitted possible definitions. From these suggestions, a steering committee distilled critical components: eclampsia: 23, amniotic fluid embolism: 15, pregnancy-related hysterectomy: 11, severe primary postpartum haemorrhage: 19, uterine rupture: 20, abnormally invasive placentation: 12, spontaneous haemoperitoneum in pregnancy: 16, and cardiac arrest in pregnancy: 10. These components were assessed by the expert panel using a 5-point Likert scale, following which a framework for an encompassing definition was constructed. Possible definitions were evaluated in rounds until a rate of agreement of more than 70% was reached. Expert commentaries were used in each round to improve definitions. Main outcome measures: Definitions with a rate of agreement of more than 70%. Results: The invitation to participate in one or more of eight Delphi processes was accepted by 103 experts from 13 high-income countries. Consensus definitions were developed for all of the conditions. Conclusion: Consensus definitions for eight morbidity conditions were successfully developed using the Delphi process. These should be used in national registrations and international studies, and should be taken up by the Core Outcomes in Women's and Newborn Health initiative. Tweetable abstract: Consensus definitions for eight morbidity conditions were successfully developed using the Delphi process.

Published
2019

45. Clinical characteristics of women captured by extending the definition of severe postpartum haemorrhage with 'refractoriness to treatment': a cohort study

Author

Henriquez, D, Gillissen, A, Smith, SM, Cramer, RA, van den Akker, T, Zwart, JJ, van Roosmalen, JJ, Bloemenkamp, KW, Bom, JG, Adriaanse, HJ, Akker, ESA, Baas, MI, Bank, CMC, Beek, E, de Boer, BAG, Boer, K, van der Borden, DMR, Bremer, HA, Brons, JTJ, Burggraaff, JM, Ceelie, H, Chon, H, Cikot, JLM, Delemarre, FMC, Diris, JHC, Doesburg-van Kleffens, M, van Dooren, IMA, van Duijnhoven, JLP, van Dunn, FM, Duvekot, J.J., Engbers, P, Hulst, MJW, Feitsma, H, Fouraux, MA, Franssen, MT, Frasa, MAM, van Gammeren, AJ, Gemund, N, Graaf, F, Groot, CJM, Hackeng, CM, van der Ham, DP, Hanssen, M, Hasaart, THM, Hendriks, HA, Henskens, YMC, Hermsen, BBJ, Hogenboom, S, Hooker, A, Hudig, F, Huijssoon, AMG, Huisjes, AJM, Jonker, N, Kabel, PJ, van Kampen, C, de Keijzer, MH, van de Kerkhof, DH, Keuren, JFW, Kleiverda, G, Klinkspoor, JH, Koehorst, SGA, Kok, M, Kok, RD, de Kok, JB, Koops, A, Kortlandt, W, Langenveld, J, Leers, MPG, Leyte, A, de Mare, A, Martens, GDM, Meekers, JH, van Meir, CA, Metz, GCH, Michielse, E, Mostert, LJ, Bijvank, S, Oostenveld, E, Osmanovic, N, Oudijk, MA, Mirani-Oostdijk, CP, van Pampus, E C M, Papatsonis, DNM, Peters, RHM, Ponjee, GA, Pontesilli, M, Porath, MM, Post, MS, Pouwels, JGJ, Prinzen, L, Roelofsen, JMT, Rondeel, JJM, van der Salm, PCM, Scheepers, HCJ, Schippers, DH, Schuitemaker, NWE, Sikkema, JM, Slomp, J, Smit, JWA, Snuif-de Lange, YS, van der Stappen, JWJ, Steures, P, Tax, GHM, Treskes, M, Ulenkate, H, van Unnik, GA, van der Veen, BS, Verhagen, TEM, Versendaal, J, Visschers, B, Visser, O, Visser, H, De Vooght, KMK, Vries, MJ, Waard, H, Weerkamp, F, Weinans, MJN, de Wet, H, Wijnen, M (Mandy), van Wijngaarden, WJ, de Wit, AC, Woiski, MD, TeMp, OHSG, Henriquez, D, Gillissen, A, Smith, SM, Cramer, RA, van den Akker, T, Zwart, JJ, van Roosmalen, JJ, Bloemenkamp, KW, Bom, JG, Adriaanse, HJ, Akker, ESA, Baas, MI, Bank, CMC, Beek, E, de Boer, BAG, Boer, K, van der Borden, DMR, Bremer, HA, Brons, JTJ, Burggraaff, JM, Ceelie, H, Chon, H, Cikot, JLM, Delemarre, FMC, Diris, JHC, Doesburg-van Kleffens, M, van Dooren, IMA, van Duijnhoven, JLP, van Dunn, FM, Duvekot, J.J., Engbers, P, Hulst, MJW, Feitsma, H, Fouraux, MA, Franssen, MT, Frasa, MAM, van Gammeren, AJ, Gemund, N, Graaf, F, Groot, CJM, Hackeng, CM, van der Ham, DP, Hanssen, M, Hasaart, THM, Hendriks, HA, Henskens, YMC, Hermsen, BBJ, Hogenboom, S, Hooker, A, Hudig, F, Huijssoon, AMG, Huisjes, AJM, Jonker, N, Kabel, PJ, van Kampen, C, de Keijzer, MH, van de Kerkhof, DH, Keuren, JFW, Kleiverda, G, Klinkspoor, JH, Koehorst, SGA, Kok, M, Kok, RD, de Kok, JB, Koops, A, Kortlandt, W, Langenveld, J, Leers, MPG, Leyte, A, de Mare, A, Martens, GDM, Meekers, JH, van Meir, CA, Metz, GCH, Michielse, E, Mostert, LJ, Bijvank, S, Oostenveld, E, Osmanovic, N, Oudijk, MA, Mirani-Oostdijk, CP, van Pampus, E C M, Papatsonis, DNM, Peters, RHM, Ponjee, GA, Pontesilli, M, Porath, MM, Post, MS, Pouwels, JGJ, Prinzen, L, Roelofsen, JMT, Rondeel, JJM, van der Salm, PCM, Scheepers, HCJ, Schippers, DH, Schuitemaker, NWE, Sikkema, JM, Slomp, J, Smit, JWA, Snuif-de Lange, YS, van der Stappen, JWJ, Steures, P, Tax, GHM, Treskes, M, Ulenkate, H, van Unnik, GA, van der Veen, BS, Verhagen, TEM, Versendaal, J, Visschers, B, Visser, O, Visser, H, De Vooght, KMK, Vries, MJ, Waard, H, Weerkamp, F, Weinans, MJN, de Wet, H, Wijnen, M (Mandy), van Wijngaarden, WJ, de Wit, AC, Woiski, MD, and TeMp, OHSG

Published
2019

47. Effectiveness of Stabilization of Preterm Infants With Intact Umbilical Cord Using a Purpose-Built Resuscitation Table-Study Protocol for a Randomized Controlled Trial

Author

Knol, Ronny, Brouwer, E, Klumper, F, van den Akker, T, Dekoninck, Philip, Hutten, GJ, Lopriore, E, van Kaam, AH, Polglase, GR, Reiss, Irwin, Hooper, SB, te Pas, AB, Knol, Ronny, Brouwer, E, Klumper, F, van den Akker, T, Dekoninck, Philip, Hutten, GJ, Lopriore, E, van Kaam, AH, Polglase, GR, Reiss, Irwin, Hooper, SB, and te Pas, AB

Published
2019

48. Risk factors, management, and outcomes of amniotic fluid embolism: A multicountry, population-based cohort and nested casecontrol study

Author

Fitzpatrick, KE, Van Den Akker, T, Bloemenkamp, KWM, Deneux-Tharaux, C, Kristufkova, A, Li, Z, Schaap, TP, Sullivan, EA, Tuffnell, D, Knight, M, Fitzpatrick, KE, Van Den Akker, T, Bloemenkamp, KWM, Deneux-Tharaux, C, Kristufkova, A, Li, Z, Schaap, TP, Sullivan, EA, Tuffnell, D, and Knight, M

Abstract

© 2019 Fitzpatrick et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Background Amniotic fluid embolism (AFE) remains one of the principal reported causes of direct maternal mortality in high-income countries. However, obtaining robust information about the condition is challenging because of its rarity and its difficulty to diagnose. This study aimed to pool data from multiple countries in order to describe risk factors, management, and outcomes of AFE and to explore the impact on the findings of considering United Kingdom, international, and United States AFE case definitions. Methods and findings A population-based cohort and nested case-control study was conducted using the International Network of Obstetric Survey Systems (INOSS). Secondary data on women with AFE (n = 99-218, depending on case definition) collected prospectively in population-based studies conducted in Australia, France, the Netherlands, Slovakia, and the UK were pooled along with secondary data on a sample of control women (n = 4,938) collected in Australia and the UK. Risk factors for AFE were investigated by comparing the women with AFE in Australia and the UK with the control women identified in these countries using logistic regression. Factors associated with poor maternal outcomes (fatality and composite of fatality or permanent neurological injury) amongst women with AFE from each of the countries were investigated using logistic regression or Wilcoxon rank-sum test. The estimated incidence of AFE ranged from 0.8-1.8 per 100,000 maternities, and the proportion of women with AFE who died or had permanent neurological injury ranged from 30%-41%, depending on the case definition. However, applying different case definitions did not materially alter findings regarding risk factors for AFE and factors

Published
2019

50. Effect of COVID-19 lockdown on maternity care and maternal outcome in the Netherlands: a national quasi-experimental study.

Author

Gravesteijn, B.Y., Boderie, N.W., van den Akker, T., Bertens, L.C.M., Bloemenkamp, K., Burgos Ochoa, L., de Jonge, A., Kazemier, B.M., Klein, P.P.F., Kwint-Reijnders, I., Labrecque, J.A., Mol, B.W., Obermann-Borst, S.A., Peters, L., Ravelli, A.C.J., Rosman, A., Been, J.V., and de Groot, C.J.

Subjects
*CESAREAN section, *MATERNAL health services, *MEDICAL care, *PRIMARY health care, *PREGNANCY outcomes, *DESCRIPTIVE statistics, *POSTPARTUM hemorrhage, *STAY-at-home orders, *DISEASES, *EPISIOTOMY, *CHILDBIRTH at home, *RESEARCH methodology, *CONFIDENCE intervals, *COVID-19 pandemic, *REGRESSION analysis
Abstract

The COVID-19 pandemic and associated lockdowns disrupted health care worldwide. High-income countries observed a decrease in preterm births during lockdowns, but maternal pregnancy–related outcomes were also likely affected. This study investigates the effect of the first COVID-19 lockdown (March–June 2020) on provision of maternity care and maternal pregnancy–related outcomes in the Netherlands. National quasi-experimental study. Multiple linked national registries were used, and all births from a gestational age of 24+0 weeks in 2010–2020 were included. In births starting in midwife-led primary care, we assessed the effect of lockdown on provision of care. In the general pregnant population, the impact on characteristics of labour and maternal morbidity was assessed. A difference-in-regression-discontinuity design was used to derive causal estimates for the year 2020. A total of 1,039,728 births were included. During the lockdown, births to women who started labour in midwife-led primary care (49%) more often ended at home (27% pre-lockdown, +10% [95% confidence interval: +7%, +13%]). A small decrease was seen in referrals towards obstetrician-led care during labour (46%, −3% [−5%,−0%]). In the overall group, no significant change was seen in induction of labour (27%, +1% [−1%, +3%]). We found no significant changes in the incidence of emergency caesarean section (9%, −1% [−2%, +0%]), obstetric anal sphincter injury (2%, +0% [−0%, +1%]), episiotomy (21%, −0% [−2%, +1%]), or post-partum haemorrhage: >1000 ml (6%, −0% [−1%, +1%]). During the first COVID-19 lockdown in the Netherlands, a substantial increase in homebirths was seen. There was no evidence for changed available maternal outcomes, suggesting that a maternity care system with a strong midwife-led primary care system may flexibly and safely adapt to external disruptions. [ABSTRACT FROM AUTHOR]

Published
2024
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