Botulinum Toxin Injection for Internal Rotation Contractures in Brachial Plexus Birth Palsy. A Minimum 5-Year Prospective Observational Study.

Background: Brachial plexus birth palsy is frequently associated with internal rotation contractures of the shoulder as a result of muscle imbalance. The purpose of this study is to assess the effect of botulinum toxin A (BTX-A) injection in the subscapular (SC) muscle on external rotation and the need for tendon transfer for external rotation of the shoulder.

Methods: A prospective comparative study was performed including 15 consecutive patients treated with BTX-A and a historic control group of 67 patients with mean age 30 months (SD 10).

Fetal exposure to HIV-1 alters chemokine receptor expression by CD4+T cells and increases susceptibility to HIV-1.

Absolute numbers of lymphocytes are decreased in uninfected infants born to HIV-1-infected women (HIV-1-exposed). Although the exact mechanism is unknown, fetal exposure to maternal HIV-1-infection could prime the immune system and affect T cell trafficking. We compared the expression of chemokine receptors on cord blood CD4(+) T cells from HIV-1-exposed children and healthy controls.

Memory CD4(+)CCR5(+) T cells are abundantly present in the gut of newborn infants to facilitate mother-to-child transmission of HIV-1.

Despite potential clinical importance, target cells for mother-to-child transmission of HIV-1 have not yet been identified. Cord blood-derived CD4(+) T cells are largely naive and do not express CCR5, the mandatory coreceptor for transmitted HIV-1 R5 strains in infants. In the present study, we demonstrate that in the human fetal and infant gut mucosa, there is already a large subset of mucosal memory CD4(+)CCR5(+) T cells with predominantly a Th1 and Th17 phenotype.

Association of three different techniques to measure blood pressure in the first trimester with the development of hypertensive disorders of pregnancy.

Objective: It is not known whether automated devices for measuring blood pressure perform better than conventional sphygmomanometry in predicting preeclampsia. This study compares two different automated devices with conventional sphygmomanometry for their association with development of preeclampsia or gestational hypertension.

Design: Prospective observational cohort study.

Hcv coinfection, an important risk factor for hepatotoxicity in pregnant women starting antiretroviral therapy.

Objectives: This retrospective cohort study evaluated the risk of hepatotoxicity in HIV-1 positive pregnant and non-pregnant women starting combined ART.

Methods: Data were used from the ATHENA observational cohort. The study population consisted of HIV-1 infected, therapy naïve, pregnant and non-pregnant women, followed between January 1997 and February 2008.

Complications of the 2009 influenza A/H1N1 pandemic in pregnant women in The Netherlands: a national cohort study.

The 2009 influenza A/H1N1 pandemic caused an increase in complications in pregnant women. To be well prepared for a next pandemic, we investigated the obstetric and maternal complications of this pandemic. In our national cohort of 59 pregnant women who were admitted to the hospital, no major complications apart from preterm birth and admission to the neonatal intensive care unit were observed.

Utilizing new evidence in the prevention of recurrent preterm birth.

Objective: Treatments that have proven to be effective in large randomized controlled trials are implemented in clinical practice at varying rates. We measured to what extent new and established strategies were applied to prevent recurrent preterm birth in the Netherlands.

Methods: In two academic hospitals, two non-academic teaching hospitals and two non-academic, non-teaching hospitals, we reviewed charts of all women who had delivered in 2006 and at that time had a history of spontaneous preterm birth before 34 weeks.

Antenatal screening for HIV, hepatitis B and syphilis in the Netherlands is effective.

Background: A screening programme for pregnant women has been in place since the 1950s in the Netherlands. In 2004 universal HIV screening according to opting out was implemented. Here, we describe the evaluation of the effectiveness of antenatal screening in the Netherlands for 2006-2008 for HIV, hepatitis B virus (HBV) and syphilis in preventing mother-to-child transmission, by using various data sources.

The functions of microparticles in pre-eclampsia.

Pre-eclampsia (P-EC), a heterogenic multisystem disorder characterized by hypertension and proteinuria, usually develops in the second half of pregnancy. The incidence is 2 to 5%, and P-EC is therefore a major cause of maternal and perinatal morbidity and mortality. Although the exact etiology is unknown, placental factors released into the maternal circulation lead to systemic maternal inflammation and endothelial dysfunction.

The comparison of the performance of two screening strategies identifying newly-diagnosed HIV during pregnancy.

Background: In the Netherlands, a non-selective opt-out instead of a selective opt-in antenatal HIV screening strategy was implemented in 2004. In case of infection, screening was followed by prevention of mother-to-child-transmission (PMTCT). We compared the performance of the two strategies in terms of detection of new cases of HIV and vertical transmission.

Does physical activity in leisure time early in pregnancy reduce the incidence of preeclampsia or gestational hypertension?

Objective: Assessment of the association of physical activity in leisure time with preeclampsia and gestational hypertension in nulliparous women.

Design: Population based prospective cohort study.

Setting: Amsterdam, The Netherlands.

Use of progesterone treatment for the prevention of recurrent preterm birth: identification of obstacles to change.

Progesterone treatment has proven to be effective in preventing recurrent preterm birth. The use of progesterone varies widely between different obstetric clinics in the Netherlands. The study aimed to identify factors that hamper or facilitate the use of progesterone to create an implementation strategy.

[Treatment of HIV-infected pregnant women: prevention of virus transmission and adverse effects in mother and child].

Without intervention, the probability of HIV transmission from mother to child varies from less than 10% to over 60%, dependent on the quantity of freely circulating HIV in the plasma. The prevention of HIV transmission from mother to child is based on the perinatal administration of a combination of antiretroviral drugs (highly active antiretroviral therapy; HAART) to both mother and child. The value of elective caesarean section along with an effective treatment with HAART during the pregnancy is very limited.

Limited accuracy of the hyperbaric index, ambulatory blood pressure and sphygmomanometry measurements in predicting gestational hypertension and preeclampsia.

Objective: The aim of this study was to validate the hyperbaric index (HBI) for first trimester prediction of preeclampsia and gestational hypertension.

Methods: Participants were low-risk and high-risk nulliparous women and high-risk multiparous women, and were recruited between April 2004 and June 2006. At a gestational age of 9 weeks (range 8-11 weeks), blood pressure (BP) was measured first by sphygmomanometry and thereafter by ambulatory BP measurement (ABPM) for 48 h.

Leukocyte activation and circulating leukocyte-derived microparticles in preeclampsia.

Problem: Preeclampsia shows characteristics of an inflammatory disease including leukocyte activation. Analyses of leukocyte-derived microparticles (MP) and mRNA expression of inflammation-related genes in leukocytes may establish which subgroups of leukocytes contribute to the development of preeclampsia.

Method Of Study: Blood samples were obtained from preeclamptic patients, normotensive pregnant and non-pregnant controls.

Brain ultrasonography findings in neonates with exposure to cocaine during pregnancy.

Background: Cocaine exposure during pregnancy has been reported to have detrimental effects on the fetus.

Objective: To describe the findings on cranial ultrasonography (CUS) as part of a neonatal screening programme for exposed neonates.

Materials And Methods: The study was a semiprospective analysis of a 12-year cohort of neonates born to mothers who had used cocaine during their pregnancy and who had follow-up according to a strict clinical protocol.

Changes in microparticle numbers and cellular origin during pregnancy and preeclampsia.

Background: Microparticles (MP) are pro-coagulant vesicles derived from various cells. Evidence is accumulating that MP are of pathophysiological relevance in autoimmune, cardiovascular, and thromboembolic diseases and inflammatory disorders. Therefore, their role in the development of preeclampsia was investigated and MP from preeclamptic patients influenced endothelial-dependent vasodilatation.

Progesterone for the prevention of preterm birth in women with multiple pregnancies: the AMPHIA trial.

Background: 15% of multiple pregnancies ends in a preterm delivery, which can lead to mortality and severe long term neonatal morbidity. At present, no generally accepted strategy for the prevention of preterm birth in multiple pregnancies exists. Prophylactic administration of 17-alpha hydroxyprogesterone caproate (17OHPC) has proven to be effective in the prevention of preterm birth in women with singleton pregnancies with a previous preterm delivery.

Microparticle-associated P-selectin reflects platelet activation in preeclampsia.

Platelet activation in preeclampsia is reflected by elevated levels of platelets exposing P-selectin. In plasma, a non-cell bound (soluble) form of P-selectin is present. Elevated levels of this soluble form have been reported in preeclampsia.

Sensitivity of spontaneous baroreflex control of the heart and hemodynamic parameters are not influenced by the menstrual cycle.

Objective: The purpose of this study was to evaluate if hemodynamic parameters and sympathetic activity vary between the follicular and luteal phase of the menstrual cycle before using sympathetic activity in pre-pregnancy risk assessment for preeclampsia.

Methods: We studied 39 healthy women at days 5 to 10 and days 18 to 25 of the menstrual cycle. Blood pressure, heart rate, cardiac output, and total peripheral resistance were measured continuously using noninvasive finger arterial pressure waveform registration (Portapres Model 2, BMI, The Netherlands).

Expression of inflammation-related genes in endothelial cells is not directly affected by microparticles from preeclamptic patients.

Background: Inflammation and endothelial dysfunction are prominent in preeclampsia. Microparticles (MPs) may link these processes, as MPs induce the production of pro-inflammatory cytokines by endothelial cells and cause endothelial dysfunction.

Aim: To study changes in expression of inflammation-related genes in human endothelial cells in response to MPs from preeclamptic patients.

Haematological parameters of HIV-1-uninfected infants born to HIV-1-infected mothers.

Aim: To investigate haematological parameters in infants born to HIV-1-infected mothers and exposed to combination antiretroviral therapy (ART) used to prevent mother-to-child transmission (MTCT).

Methods: A 2-y single-centre follow-up study performed in 109 infants born to HIV-1-positive mothers. Exclusion criteria for the infants were HIV-1 infection, perinatal death, or insufficient information.

Nelfinavir and nevirapine side effects during pregnancy.

Background: The risk of vertical transmission of HIV has been substantially reduced since the introduction of highly active antiretroviral therapy (HAART); however, the impact of taking HAART during pregnancy on the woman, the fetus and the infant is not yet understood.

Objective: To assess and compare tolerability, safety and efficacy of nelfinavir- or nevirapine-containing HAART in a cohort of pregnant and non-pregnant HIV-infected women in The Netherlands.

Design: Retrospective comparative study.

Short-term (0-48 h) effects of maternal betamethasone administration on fetal heart rate and its variability.

The short-term (0-48 h) effects of maternal betamethasone administration on computerized fetal heart rate (FHR) parameters were studied in 36 pregnancies at increased risk for preterm delivery. FHR was recorded for 90 min immediately before the start of betamethasone treatment and again at 6-h intervals during the next 48 h. Multiple linear regression models were used to assess the possible effects on FHR parameters of gestational age, time of day, clinical indication for treatment, and use of tocolytic drugs.