Identification of cases with adverse neonatal outcome monitored by cardiotocography versus ST analysis: secondary analysis of a randomized trial.

Objective: To evaluate whether correct adherence to clinical guidelines might have led to prevention of cases with adverse neonatal outcome.

Design: Secondary analysis of cases with adverse outcome in a multicenter randomized clinical trial.

Setting: Nine Dutch hospitals.

Neonatal morbidity in term neonates is related to gestational age at birth and level of care.

Aims: The objective of this study was to assess whether the incidence of neonatal morbidity of neonates born at term and admitted to a neonatal intensive care unit (NICU) differs by gestational age and level of care.

Methods: This is a 5-year retrospective cohort study of singleton term births admitted to the NICU of the VU University Medical Center with a gestational age ≥37+0 weeks.

Results: In total, 497 neonates were included in the study.

Prediction of neonatal metabolic acidosis in women with a singleton term pregnancy in cephalic presentation.

We sought to predict neonatal metabolic acidosis at birth using antepartum obstetric characteristics (model 1) and additional characteristics available during labor (model 2). In 5667 laboring women from a multicenter randomized trial that had a high-risk singleton pregnancy in cephalic presentation beyond 36 weeks of gestation, we predicted neonatal metabolic acidosis. Based on literature and clinical reasoning, we selected both antepartum characteristics and characteristics that became available during labor.

Cost-effectiveness of cardiotocography plus ST analysis of the fetal electrocardiogram compared with cardiotocography only.

Objective: To assess the cost-effectiveness of addition of ST analysis of the fetal electrocardiogram (ECG; STAN) to cardiotocography (CTG) for fetal surveillance during labor compared with CTG only.

Design: Cost-effectiveness analysis based on a randomized clinical trial on ST analysis of the fetal ECG.

Setting: Obstetric departments of three academic and six general hospitals in The Netherlands.

Cardiotocography plus ST analysis of fetal electrocardiogram compared with cardiotocography only for intrapartum monitoring: a randomized controlled trial.

Objective: To estimate the effectiveness of intrapartum fetal monitoring by cardiotocography plus ST analysis using a strict protocol for performance of fetal blood sampling.

Methods: We performed a multicenter randomized trial among laboring women with a high-risk singleton pregnancy in cephalic presentation beyond 36 weeks of gestation. Participants were assigned to monitoring by cardiotocography with ST analysis (index) or cardiotocography only (control).

Recurrent incarceration of the gravid uterus.

Incarceration of the gravid uterus is a rare phenomenon, associated with maternal and fetal morbidity and mortality. A 37-year-old gravida 2 para 1 develops a recurrent incarceration in her second pregnancy. Therefore, examination and follow-up early in the next pregnancy is advised.

Adverse drug reactions to tocolytic treatment for preterm labour: prospective cohort study.

Objective: To evaluate the incidence of serious maternal complications after the use of various tocolytic drugs for the treatment of preterm labour in routine clinical situations.

Design: Prospective cohort study.

Setting: 28 hospitals in the Netherlands and Belgium.

Misidentification of maternal for fetal heart rate patterns after delivery of the first twin.

Background: The 2nd born in twin delivery is at higher risk of fetal asphyxia. We tested the hypothesis that inadequate, fetal heart rate (FHR) monitoring has contributed to an inadvertent outcome.

Study Design: A database was reviewed consisting of 41 twin deliveries with a pH in the umbilical artery of the 2nd twin below 7.

Metastatic renal cell cancer in a 20-year-old pregnant woman.

We report unusual magnetic resonance imaging findings of a 20-year-old pregnant woman at 18 weeks of gestation who was diagnosed with metastatic renal cell cancer (RCC) with a large liver metastasis.

The quality of intrapartum uterine activity monitoring.

Aims: To determine the quality of intrapartum uterine activity (UA) monitoring in daily practice during the first and second stage of labor. The total duration of inadequate UA monitoring is quantified in relation to the technique applied: external or internal.

Methods: One hundred and ninety-two UA recordings, collected from 1 April 2006 untill 1 October 2006 from consecutive deliveries at the Vrije Universiteit Medical Center in Amsterdam, were analyzed.

Fetal brain sonography and fetal heart rate patterns in the preterm fetus.

Objective: The objective of the study was to study whether peri- and intraventricular echodensities in the brain of fetuses at risk for preterm birth are associated with changes in fetal heart rate (FHR) parameters.

Study Design: Twenty preterm fetuses with peri- and intraventricular echodensities detected by transvaginal ultrasonography were matched with 20 fetuses without echodensities for gestational age, growth parameters, clinical disease, and maternal medication. Baseline FHR, long- and short-term variability, and the presence of accelerations and decelerations were analyzed with a computerized system and compared with the Wilcoxon matched-pairs signed-rank test.

Uterine activity: implications for the condition of the fetus.

Aim: The aim of this review is to provide more insight in the fetal mechanisms as a response to uterine contractions and to emphasize the importance of correct assessment of uterine activity (UA) patterns during labor.

Study Results: UA causes a decreased flow through the uterine artery. In the healthy uncompromised fetus, this will not cause fetal acidemia.

Use of recombinant activated factor VII in primary postpartum hemorrhage: the Northern European registry 2000-2004.

Objective: To collect data from nine European countries for cases of obstetric hemorrhage between 2000 and 2004 in which recombinant activated factor VII (rFVIIa) was used.

Methods: The cases were identified through national surveys. Standardized case report forms included sociodemographic details, past medical and obstetric history, and details of the progress and management of labor in which the postpartum hemorrhage occurred.

Uterine activity monitoring during labor.

Aim: To summarize the currently available knowledge on (1) the methods to monitor uterine activity (UA); (2) the units to quantify UA; and (3) to assess the importance of abnormal contraction patterns on the condition of the fetus. The need for correct assessment and interpretation of the uterine contraction curve to improve fetal outcome will be emphasized.

Study Results: Correct assessment of the uterine contraction curve is an essential part of the cardiotocogram and should be obtained by the best method available; i.

Use of recombinant activated factor VII in massive postpartum haemorrhage.

Objective: Postpartum haemorrhage (PPH) remains an important cause of maternal morbidity and mortality. With regard to morbidity, preservation of the uterus is of paramount importance in fertile women. The objective of the study was to describe the cumulative experience of a cohort of women that were treated with recombinant factor VIIa.

Nifedipine pharmacokinetics and plasma levels in the management of preterm labor.

The aim of this study was to determine if the dose regimen of nifedipine used for tocolysis was effective to achieve uterine quietness, and at which plasma concentration levels this tocolysis was achieved to optimize our dose regimen of nifedipine. In women with preterm labor, nifedipine was administered orally to achieve uterine quietness to prevent preterm birth. Patients (n = 5) were administered 10 mg nifedipine capsules (Adalat capsules, Bayer AG) orally every 15 minutes up to 40 mg in the first hour, and were subsequently given 1 tablet of 20 mg nifedipine slow release (Adalat retard, Bayer AG) t = 90 min.

A randomised clinical trial on cardiotocography plus fetal blood sampling versus cardiotocography plus ST-analysis of the fetal electrocardiogram (STAN) for intrapartum monitoring.

Background: Cardiotocography (CTG) is worldwide the method for fetal surveillance during labour. However, CTG alone shows many false positive test results and without fetal blood sampling (FBS), it results in an increase in operative deliveries without improvement of fetal outcome. FBS requires additional expertise, is invasive and has often to be repeated during labour.

Managing the risks of off-licence prescribing in pregnancy.

The dearth of randomised controlled trials confirming the efficacy, quality and safety of drugs used in pregnant women means that off-licence prescribing in this vulnerable patient population is commonplace. If a licenced drug harms a patient, the responsibility lies with the manufacturer. When an off-licence drug causes harm, the responsibility lies with the doctor.

TNF-receptor levels in preeclampsia--results of a longitudinal study in high-risk women.

Objective: Tumor necrosis factor-alpha (TNF-alpha) is thought to play a role in immune activation in preeclampsia. The objective of this study was to establish if soluble TNF-receptor I (sTNF-rI) levels relate to the onset and severity of preeclampsia.

Methods: Maternal plasma sTNF-rI levels were studied throughout pregnancy in 68 women with a history of severe preeclampsia or intra-uterine growth restriction (IUGR), and primigravidas with chronic hypertension.

The quality of nifedipine studies used to assess tocolytic efficacy: a systematic review.

Objective: To assess the quality of studies of nifedipine used to treat spontaneous preterm labor.

Design: A systematic review of study quality using a novel validity assessment tool, examining method-specific and topic-specific items in the domains of selection, performance and measurement biases.

Data Sources: Medline (1996-2003), EMBASE (1996-2003), BIOSIS (1993-2003), Current Contents (1995-2003), DERWENT DRUGFILE (1983-2003), Cochrane Database of Systematic Reviews.

Does intra-uterine environment influence fetal head-position preference? A comparison between breech and cephalic presentation.

Background: Cephalic fetuses have increasing lateralised head-position near term.

Aim: Is this development affected by breech presentation?

Subjects And Methods: Fetal head-position was studied longitudinally in 13 healthy fetuses in breech presentation and 10 healthy fetuses in cephalic presentation by means of real-time ultrasound. Recordings were obtained weekly from 33 weeks gestational age until birth.

Nifedipine trials: effectiveness and safety aspects.

Nifedipine (Adalat) is marketed as an anti-hypertensive agent. Nifedipine inhibits voltage-dependent L-type calcium channels, which leads to vascular (and other) smooth muscle relaxation and negative inotropic and chronotropic effects on the heart. Vasodilation, followed by a baroreceptor-mediated increase in sympathetic tone then results in indirect cardiostimulation.

Strategies for prevention--cervical cerclage.

Transvaginal cervical cerclage was introduced as a treatment for cervical incompetence in 1951. Over the years, our understanding of this clinical entity has changed tremendously, which has implications for obstetric management. This review focuses on the obstetric management of women considered to be at high risk of preterm delivery due to cervical incompetence at different stages of pregnancy.

Ketanserin in women with chronic hypertension and underlying thrombophilia.

Background: Pregnant women with chronic hypertension and thrombophilia have an increased risk for preeclampsia and/or intrauterine growth restriction (IUGR). Ketanserin lowers blood pressure and inhibits serotonin-induced platelet aggregation.

Cases: A 38-year-old woman with chronic hypertension had a first pregnancy with severe hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome.