Fetal heart rate abnormalities during and after external cephalic version: Which fetuses are at risk and how are they delivered?

Background: Fetal heart rate abnormalities (FHR) during and after external cephalic version (ECV) are relatively frequent. They may raise concern about fetal wellbeing. Only occasionally they may lead to an emergency cesarean section.

[A postpartum woman with toxic shock syndrome: group A streptococcal infection, a much feared postpartum complication.].

Background: The development of toxic shock syndrome (TSS) after an invasive group A streptococcal (GAS) infection in the postpartum period is a much feared complication. The mortality rate of TSS with necrotizing fasciitis is 30 to 50%.

Case Description: We present the case of a woman with atypical pelvic pain which was the first symptom of toxic shock syndrome as a consequence of a GAS infection.

Development and Measurement of Guidelines-Based Quality Indicators of Caesarean Section Care in the Netherlands: A RAND-Modified Delphi Procedure and Retrospective Medical Chart Review.

Background: There is an ongoing discussion on the rising CS rate worldwide. Suboptimal guideline adherence may be an important contributor to this rise. Before improvement of care can be established, optimal CS care in different settings has to be defined.

Increased maternal TSH and decreased maternal FT4 are associated with a higher operative delivery rate in low-risk pregnancies: A prospective cohort study.

Background: The increasing number of operative deliveries is a topic of major concern in modern obstetrics. Maternal thyroid function is of known influence on many obstetric parameters. Our objective was to investigate a possible relation between maternal thyroid function, and operative deliveries.

Maternal thyrotropin is independently related to small for gestational age neonates at term.

Objective: Small for gestational age (SGA) newborns constitute still a major cause of perinatal morbidity and mortality. Overt thyroid disease is a known cause of preterm birth and low birthweight but in its untreated condition it is rare today. In this study, we investigated the possible relation between maternal thyroid function assessed in euthyroid women at each trimester and the incidence of term born SGA neonates.

Prediction of preterm birth in multiple pregnancies: development of a multivariable model including cervical length measurement at 16 to 21 weeks' gestation.

Objective: To develop a multivariable prognostic model for the risk of preterm delivery in women with multiple pregnancy that includes cervical length measurement at 16 to 21 weeks' gestation and other variables.

Methods: We used data from a previous randomized trial. We assessed the association between maternal and pregnancy characteristics including cervical length measurement at 16 to 21 weeks' gestation and time to delivery using multivariable Cox regression modelling.

Maternal thyrotrophin in euthyroid women is related to meconium stained amniotic fluid in women who deliver at or over 41 weeks of gestation.

Background: Maternal thyroid dysfunction is of known influence on pregnancies in the preterm period. However little is known about its effect on term and post term pregnancies. Meconium stained amniotic fluid (MSAF) is known to occur preferentially in (post)term pregnancies.

The aetiology of meconium-stained amniotic fluid: pathologic hypoxia or physiologic foetal ripening? (Review).

Introduction: Despite the many efforts to study the (patho)physiology of meconium release before delivery, it still remains an indistinct subject. Some studies have reported a relationship between hypoxia and MSAF, whilst others have not. The most common association found however, is between MSAF and the term of gestation.

Fear for external cephalic version and depression: predictors of successful external cephalic version for breech presentation at term?

Background: Objective was to determine whether fear for external cephalic version (ECV) and depression are associated with the success rate of ECV in women with a breech presentation at term.

Methods: Prospective study conducted in the Catharina Hospital Eindhoven between October 2007 and May 2012. Participants fulfilled The Edinburgh Depression Scale (EDS) questionnaire and expressed their degree of fear on a visual analogue scale from one to ten before ECV.

[Shock in pregnancy: foetal distress may be the first symptom].

Shock may be difficult to recognize in pregnant women due to the physiological changes that take place in the cardiovascular system. The first symptom of shock may be foetal distress. We present two patients to illustrate this condition.

Involving women in personalised decision-making on mode of delivery after caesarean section: the development and pilot testing of a patient decision aid.

Objective: To develop a patient decision aid (PtDA) for mode of delivery after caesarean section that integrates personalised prediction of vaginal birth after caesarean (VBAC) with the elicitation of patient preferences and evidence-based information.

Design: A PtDA was developed and pilot tested using the International Patients Decision Aid Standards (IPDAS) criteria.

Setting: Obstetric health care in the Netherlands.

Mode of delivery following successful external cephalic version: comparison with spontaneous cephalic presentations at delivery.

Objective: To compare the obstetric outcomes of pregnant women after successful external cephalic version (ECV) (cases) with a large group of pregnant women with a spontaneously occurring cephalic fetal position at delivery (controls).

Methods: We conducted a retrospective matched cohort study in a teaching hospital in the Netherlands. Delivery outcomes of women with a successful ECV were compared with those of women with spontaneously occurring cephalic presentations, controlling for maternal age, parity, gestational age at delivery, and onset of labour (spontaneous or induced).

Economic analysis comparing induction of labour and expectant management for intrauterine growth restriction at term (DIGITAT trial).

Objective: Pregnancies complicated by intrauterine growth restriction (IUGR) are at increased risk for neonatal morbidity and mortality. The Dutch nationwide disproportionate intrauterine growth intervention trial at term (DIGITAT trial) showed that induction of labour and expectant monitoring were comparable with respect to composite adverse neonatal outcome and operative delivery. In this study we compare the costs of both strategies.

The effect of change in a labour management protocol on caesarean section rate in nulliparous women.

Objective: To investigate the impact on obstetric outcome in nulliparous women of changing labour management from an expectant approach to proactive support of labour.

Methods: We conducted a retrospective cohort study in a teaching hospital in the Netherlands among 858 women ≥ 37 weeks' gestation with a singleton fetus in cephalic position and spontaneous labour who planned to have a vaginal birth in the hospital under the care of an obstetrician. Exclusion criteria were gestational age < 37 weeks, induction of labour, primary Caesarean section, non-cephalic position, and non-Caucasian ethnicity.

Women's prelabour preference for epidural analgesia: a cross-sectional study among women from the Netherlands and Belgium.

Background: This study describes variables related to women's prelabour preference for epidural analgesia (PEA) in two neighbouring countries with a comparable socio-economic and cultural background.

Methods: Dutch women in midwifery (n = 164) or obstetrical care (n = 162), and Belgian women (n = 188) of ≥36 weeks gestation with a singleton in cephalic presentation completed questionnaires on demographic factors, received labour analgesia information, perceived attitude of the caregiver towards epidural analgesia (EA), pain catastrophising and coping with labour pain. Multiple logistic regression analysis was performed with PEA as dependent variable.

Does the method of dissecting in anterior colporraphy lead to a difference in thickness of removed vaginal tissue?

Objective: To evaluate the difference in thickness of the anterior vaginal wall removed after different surgical dissecting techniques of anterior colporrhaphy.

Study Design: In patients undergoing primary anterior colporrhaphy, trimmed vaginal tissue was taken following different surgical techniques of vaginal wall dissection. Tissues were preserved in formalin and stained with hematoxylin-eosin and elastica-van Giesen stains.

[Anaphylaxis after iron dextran administration in a pregnant woman].

Background: Iron deficiency is a frequent cause of anaemia in pregnancy and often results in fatigue and malaise. To prevent complications during labour, timely iron suppletion is important.

Case Description: A 30-year-old multiparous female presented at the outpatient clinic in her 38th week of this pregnancy because of fatigue and lightheadedness.

Effect of 17-alpha hydroxyprogesterone caproate on cervical length in twin pregnancies.

Objectives: Previous studies on singleton pregnancies have indicated that progestogens may reduce the rate of cervical shortening during pregnancy. The aim of this study was to investigate whether treatment with 17-alpha hydroxyprogesterone caproate (17-OHPC) has an effect on cervical shortening in twin pregnancies.

Methods: This was a secondary analysis of patients who had participated in a multicenter randomized clinical trial on the effectiveness of 17-OHPC in preventing preterm birth in multiple pregnancies (the AMPHIA-trial).

17α-hydroxyprogesterone caproate for the prevention of adverse neonatal outcome in multiple pregnancies: a randomized controlled trial.

Objective: To estimate whether administration of 17α-hydroxyprogesterone caproate can prevent neonatal morbidity in multiple pregnancies by reducing the preterm birth rate.

Methods: We conducted a multicenter, double-blind, placebo-controlled randomized trial in 55 obstetric clinics in the Netherlands. Women with a multiple pregnancy were randomized to weekly injections of either 250 mg 17α-hydroxyprogesterone caproate or placebo, starting between 16 and 20 weeks of gestation and continuing until 36 weeks of gestation.

Neonatal thyroid screening results are related to gestational maternal thyroid function.

Objective: To study the relationship between maternal thyroid function at each pregnancy trimester and neonatal screening results.

Background: Overt maternal thyroid dysfunction during gestation is associated with poor neonatal thyroid function. However, research on the relationship between suboptimal maternal thyroid function (assessed at three trimesters) and neonatal thyroid screening outcome is scarce.

The relation between umbilical cord characteristics and the outcome of external cephalic version.

Background: Umbilical cords of fetuses in breech presentation differ in length and coiling from their cephalic counterparts and it might be hypothesised that these cord characteristics may in turn affect ECV outcome.

Aim: To investigate the relation between umbilical cord characteristics and the outcome of external cephalic version (ECV).

Study Design: Prospective cohort study.

Maternal thyroid function and the outcome of external cephalic version: a prospective cohort study.

Background: To investigate the relation between maternal thyroid function and the outcome of external cephalic version (ECV) in breech presentation.

Methods: Prospective cohort study in 141 women (≥ 35 weeks gestation) with a singleton fetus in breech. Blood samples for assessing thyroid function were taken prior to ECV.

Induction versus expectant monitoring for intrauterine growth restriction at term: randomised equivalence trial (DIGITAT).

Objective: To compare the effect of induction of labour with a policy of expectant monitoring for intrauterine growth restriction near term.

Design: Multicentre randomised equivalence trial (the Disproportionate Intrauterine Growth Intervention Trial At Term (DIGITAT)).

Setting: Eight academic and 44 non-academic hospitals in the Netherlands between November 2004 and November 2008.

High thyrotrophin levels at end term increase the risk of breech presentation.

Objective: To study the relationship between maternal thyrotrophin (TSH) and breech presentation at term.

Design: Combined data sets of two prospective studies to obtain adequate epidemiological power.

Patients: One thousand and fifty-eight healthy pregnant women (58 breech, 1000 cephalic) and 131 women who presented in breech at an obstetrical outpatient clinic.