Late termination of pregnancy: a comparison of obstetricians' experience in eight European countries.

Objective: To compare the experience and attitude of obstetricians in Europe towards late termination of pregnancy and the factors affecting their responses.

Design: Cluster sampling cross-sectional survey. All neonatal intensive care unit (NICU)-associated maternity units were recruited (census sampling) in Luxembourg, the Netherlands and Sweden.

Design and evaluation of a regional perinatal audit.

Objective: To describe the experiences of a regional audit of perinatal deaths, including the experiences of the audit members, to discuss similarities and differences with other, existing perinatal audits and to summarize the implications for future implementation.

Study Design: Perinatal audit with blinded regional auditors. Consecutive cases of perinatal death were analysed for the presence of substandard care.

Ethnic differences in perinatal mortality. A perinatal audit on the role of substandard care.

Objectives: The objective was to investigate the contribution of substandard care to ethnic inequalities in perinatal mortality.

Study Design: Perinatal audit in Amsterdam, the Netherlands. The study population consisted of 137 consecutive perinatal death cases (16 weeks GA-28 days after delivery).

The architecture of first trimester chorionic villous vascularization: a confocal laser scanning microscopical study.

Background: The aim of this study was to investigate normal chorionic villous vascularization using CD31 immunofluorescence and confocal laser scanning microscopy (CLSM) to elucidate the spatial arrangement in terms of connections between vessels and cords and their branching patterns compared to deficient chorionic villous vascularization in complicated pregnancies.

Methods: A descriptive morphologic study using CLSM after CD31 immunofluorescence staining of placental biopsies from normal pregnancies (n = 20), complete hydatidiform molar pregnancies (CHMs; n = 3) and empty sacs (n = 3), with a well documented gestational age (GA).

Results: In this three-dimensional study, first trimester chorionic villi were occupied by a complex network of mainly cords with redundant connections as early as 5(+5) weeks GA.

Dutch women's decision-making in pregnancy and labour as seen through the eyes of their midwives.

Objective: a national study of midwives' perceptions of women's decision-making in the technical interventions in the birth process.

Design: questionnaire survey of women and their midwives. Midwives completed a maternity record for each woman in the study after the birth, and the women completed a demographic questionnaire at to 20-24 weeks gestation.

[Late postpartum eclampsia].

A 36-year-old woman, who had given birth once before, had an eclamptic epileptic seizure eight days after caesarean delivery of healthy premature twins. Severe headache and loss of vision, leading to blindness, had not been recognised as prodromal signs by the healthcare professionals involved. Thereafter, she suffered a generalised epileptic seizure with tongue bite.

Maternal nutrition during gestation and carotid arterial compliance in the adult offspring: the Dutch famine birth cohort.

Objective: Experimental evidence indicates that maternal undernutrition during gestation may program hypertension in the offspring. We investigated whether maternal undernutrition leads to increased arterial stiffness.

Methods: We measured carotid artery lumen diameter (LD), distensibility (DC), stiffness (beta), and compliance (CC) by M-mode ultrasound in 673 individuals, aged 56-61 years, who had been born as term singletons around the time of the 1944-45 Dutch famine.

Patient refusal of emergency cesarean delivery: a study of obstetricians' attitudes in Europe.

Objective: To compare the attitudes of a large sample of obstetricians from eight European countries toward a competent woman's refusal to consent to an emergency cesarean delivery for acute fetal distress.

Methods: Obstetricians' attitudes in response to a hypothetical clinical case were surveyed through an anonymous, self-administered questionnaire. The sample included 1,530 obstetricians (response rate 77%) from 105 maternity units (response rate 70%) in eight countries: France, Germany, Italy, Luxembourg, Netherlands, Spain, Sweden and the United Kingdom.

A possible link between prenatal exposure to famine and breast cancer: a preliminary study.

In a study of 475 women born around the 1944-1945 Dutch famine, women exposed to prenatal famine more often reported a history of breast cancer than nonexposed women (hazard ratio, 2.6; 95% confidence interval, 0.9-7.

Blood pressure response to psychological stressors in adults after prenatal exposure to the Dutch famine.

Objective: There is increasing evidence that restricted prenatal growth is associated with exaggerated blood pressure responses to stress. We investigated the effect of maternal undernutrition on the adult offspring's stress response.

Design: A historical cohort study.

Reduced intima media thickness in adults after prenatal exposure to the Dutch famine.

Background: Restricted prenatal growth is associated with an increased risk of coronary heart disease morbidity and mortality. We studied the effects of exposure to famine during gestation on intima media thickness (IMT) in later life.

Methods And Results: We studied 730 people aged 58 years who were born as term singletons around the time of the 1944-45 Dutch famine.

Early onset of coronary artery disease after prenatal exposure to the Dutch famine.

Background: Limited evidence suggests that maternal undernutrition at the time of conception is associated with increased cardiovascular disease risk in adult offspring.

Objective: We investigated whether persons conceived during the Dutch famine of World War II had an early onset of coronary artery disease (CAD).

Design: We compared the age at onset and cumulative incidence of CAD between persons born as term singletons who were exposed to the 1944-1945 Dutch famine during late (n = 160), mid- (n = 138), or early (n = 87) gestation and 590 unexposed subjects at age 50 or 58 y.

Impaired insulin secretion after prenatal exposure to the Dutch famine.

Objective: We previously reported that people prenatally exposed to famine during the Dutch Hunger Winter of 1944-1945 have higher 2-h glucose concentrations after an oral glucose tolerance test in later life. We aimed to determine whether this association is mediated through alterations in insulin secretion, insulin sensitivity, or a combination of both.

Research Design And Methods: We performed a 15-sample intravenous glucose tolerance test in a subsample of 94 normoglycemic men and women from the Dutch Famine Birth Cohort.

Hypothalamic-pituitary-adrenal axis activity in adults who were prenatally exposed to the Dutch famine.

Objective: The hypothalamic-pituitary-adrenal (HPA) axis has been proposed to be susceptible to fetal programming, the process by which an adverse fetal environment elicits permanent physiological and metabolic alterations predisposing to disease in later life. It is hypothesized that fetal exposure to poor circumstances alters the set point of the HPA axis, leading to increased HPA axis activity and subsequent increased cortisol concentrations. In this study, we tested the hypothesis that prenatal exposure to famine during different periods of gestation is associated with increased activity of the HPA axis.

Bad experience, good birthing: Dutch low-risk pregnant women with a history of sexual abuse.

Objective: The long-term effects on women in childbirth with a history of sexual abuse have only been studied to a limited degree. We estimated the prevalence of lifetime experience among low-risk pregnant women (non-clinical) in The Netherlands as well as the association with (1) psycho-social outcomes, and (2) the birth process.

Methods: Study of 625 randomly selected low-risk pregnant women.

Caesarean section on request: a comparison of obstetricians' attitudes in eight European countries.

Objective: To explore the attitudes of obstetricians to perform a caesarean section on maternal request in the absence of medical indication.

Design: Cluster sampling cross-sectional survey.

Setting: Neonatal Intensive Care Unit (NICU) associated maternity units in eight European countries.

The effects of the Pro12Ala polymorphism of the peroxisome proliferator-activated receptor-gamma2 gene on glucose/insulin metabolism interact with prenatal exposure to famine.

Objective: An adverse fetal environment may permanently modify the effects of specific genes on glucose tolerance, insulin secretion, and insulin sensitivity. In the present study, we assessed a possible interaction of the peroxisome proliferator-activated receptor (PPAR)-gamma2 Pro12Ala polymorphism with prenatal exposure to famine on glucose and insulin metabolism.

Research Design And Methods: We measured plasma glucose and insulin concentrations after an oral glucose tolerance test and determined the PPAR-gamma2 genotype among 675 term singletons born around the time of the 1944-1945 Dutch famine.

Nuchal translucency screening and anxiety levels in pregnancy and puerperium.

Objectives: To compare levels of anxiety and depression during pregnancy and puerperium between women who are offered nuchal translucency (NT) screening routinely and those who are not, and to compare levels between women accepting and those declining screening.

Methods: In 12 midwife practices in three different health districts an experimental NT screening program was offered to pregnant women between 1 June 1999 and 1 January 2001. As part of this implementation study, questionnaires including the Hospital Anxiety and Depression Scale (HADS) were completed: after the patient was informed but before screening (T1), at 20 weeks of gestation (T2), and 6 weeks after delivery (T3).

Ted (G.J.) Kloosterman: on intrauterine growth. The significance of prenatal care. Studies on birth weight, placental weight and placental index.

In the last century, there was a heated debate on whether fetal growth retardation is caused by a small placenta or whether a placenta is small because the baby is small. One of the active participants in this debate was Kloosterman who studied 80,000 birth weights, and 30,000 placental weights, in relation to gestational age at birth, fetal sex, maternal parity, and perinatal mortality. He found that pregnancies related to heavier placentas last longer.

Membrane sweeping and prevention of post-term pregnancy in low-risk pregnancies: a randomised controlled trial.

Objective: To evaluate the effectiveness of membrane sweeping at 41 weeks for the prevention of post-term pregnancy.

Design: A multicentre randomised controlled trial.

Setting: Fifty-one primary care midwifery practices in the Netherlands.

Long-term follow up of children exposed in utero to nifedipine or ritodrine for the management of preterm labour.

Objective: To compare the long-term psychosocial and motor effects on children exposed in utero to nifedipine or ritodrine for the management of preterm labour.

Design: Randomised controlled trial.

Setting: Multicentre study in two university and one primary hospital in the Netherlands.

Glucose tolerance at age 58 and the decline of glucose tolerance in comparison with age 50 in people prenatally exposed to the Dutch famine.

Aims/hypothesis: People who were small at birth have an increased risk of type 2 diabetes in later life. People who were in utero during the Dutch famine had decreased glucose tolerance and raised insulin concentrations at age 50. We aimed to evaluate whether prenatal famine exposure leads to more rapid progression of impaired glucose/insulin homeostasis with increasing age.

Women's opinions on the offer and use of nuchal translucency screening for Down syndrome.

Objective: To study the attitude of Dutch women to the offer and subsequent (non)use of nuchal translucency (NT) screening for Down syndrome in the first trimester of pregnancy, in a country where screening is not routinely offered under 36 years of age.

Methods: An experimental NT screening programme offered to pregnant women, together with a series of questionnaires to be completed before and after the offer and (non)use of screening, in 12 midwife practices in three different health districts.

Participants: Cohort of pregnant women who had their first prenatal care visit in the participating midwife practices between 1 June 1999 and 1 January 2001.