Balloon catheter for induction of labor in women with one previous cesarean and an unfavorable cervix.

Introduction: When women with a previous cesarean section and an unfavorable cervix have an indication for delivery, the choice is to induce labor or to perform a cesarean section. This study aims to assess the effectiveness and safety of a balloon catheter as a method of induction of labor in women with one previous cesarean section and an unfavorable cervix compared with an elective repeat cesarean section.

Material And Methods: We performed a prospective cohort study in 51 hospitals in the Netherlands on term women with one previous cesarean section, a live singleton fetus in cephalic position, an unfavorable cervix and an indication for delivery.

An economic analysis of immediate delivery and expectant monitoring in women with hypertensive disorders of pregnancy, between 34 and 37 weeks of gestation (HYPITAT-II).

Objective: To assess the economic consequences of immediate delivery compared with expectant monitoring in women with preterm non-severe hypertensive disorders of pregnancy.

Design: A cost-effectiveness analysis alongside a randomised controlled trial (HYPITAT-II).

Setting: Obstetric departments of seven academic hospitals and 44 non-academic hospitals in the Netherlands.

Immediate delivery versus expectant monitoring for hypertensive disorders of pregnancy between 34 and 37 weeks of gestation (HYPITAT-II): an open-label, randomised controlled trial.

Background: There is little evidence to guide the management of women with hypertensive disorders in late preterm pregnancy. We investigated the effect of immediate delivery versus expectant monitoring on maternal and neonatal outcomes in such women.

Methods: We did an open-label, randomised controlled trial, in seven academic hospitals and 44 non-academic hospitals in the Netherlands.

Prediction of neonatal outcome in women with gestational hypertension or mild preeclampsia after 36 weeks of gestation.

Background: There is little knowledge about neonatal complications in GH and PE and induction at term, we aim to assess whether they can be predicted from clinical data.

Methods: We used data of the HYPITAT trial and evaluated whether adverse neonatal outcome (Apgar score < 7, pH < 7.05, NICU admission) could be predicted from clinical data.

[Recurrent miscarriage turns out to be lung cancer].

Background: If a positive pregnancy test is followed by profuse vaginal bleeding, the diagnosis of miscarriage can generally be made. Sometimes, however, elevated hCG levels may be associated with a phantom pregnancy, which may be a paraneoplastic symptom.

Case Description: A 27-year-old woman was referred for a diagnosis after having experienced 3 consecutive miscarriages.

Cervical pessaries for prevention of preterm birth in women with a multiple pregnancy (ProTWIN): a multicentre, open-label randomised controlled trial.

Background: In women with a multiple pregnancy, spontaneous preterm delivery is the leading cause of perinatal morbidity and mortality. Interventions to reduce preterm birth in these women have not been successful. We assessed whether a cervical pessary could effectively prevent poor perinatal outcomes.

Umbilical choline and related methylamines betaine and dimethylglycine in relation to birth weight.

Background: Low birth weight (LBW) is associated with increased morbidity and mortality for the newborn and risk of chronic disease in adulthood. Choline plays an essential role in the integrity of cell membranes, methylation reactions, and memory development. We examined whether choline, betaine, and dimethylglycine (DMG) concentrations were associated with LBW in Dutch women.

Induction of labour versus expectant monitoring for gestational hypertension or mild pre-eclampsia between 34 and 37 weeks' gestation (HYPITAT-II): a multicentre, open-label randomised controlled trial.

Background: Gestational hypertension (GH) and pre-eclampsia (PE) can result in severe complications such as eclampsia, placental abruption, syndrome of Hemolysis, Elevated Liver enzymes and Low Platelets (HELLP) and ultimately even neonatal or maternal death. We recently showed that in women with GH or mild PE at term induction of labour reduces both high risk situations for mothers as well as the caesarean section rate. In view of this knowledge, one can raise the question whether women with severe hypertension, pre-eclampsia or deterioration chronic hypertension between 34 and 37 weeks of gestation should be delivered or monitored expectantly.

[Congenital toxoplasmosis: severe ocular and neurological complications].

Two infants with congenital toxoplasmosis are presented. A girl born prematurely was treated postnatally after the mother had received antimicrobial treatment during pregnancy for acute toxoplasmosis. Apart from being small for gestational age, she remained without symptoms and treatment was ceased after 13 months.

Maternal homocysteine and related B vitamins as risk factors for low birthweight.

Objective: We designed a large prospective study to explore the relationship between maternal homocysteine concentrations and related B vitamins and birthweight.

Study Design: Blood was sampled from pregnant women at 30-34 weeks of gestation and their newborn infants (n = 366).

Results: Concentrations of all analytes were higher in umbilical cord compared with maternal samples.

[Perineal infiltration anaesthesia for episiotomy: a needle which is bent manually may break off and migrate through the body].

A 28-year-old pregnant woman was given local anaesthesia in the perineum with a Monoject disposable needle in preparation for an episiotomy. The needle was bent manually in order to facilitate infiltration. During infiltration the needle broke off and disappeared.

Different pharmacokinetics of tramadol in mothers treated for labour pain and in their neonates.

Objective: The aim of the present study was to investigate the pharmacokinetic profile of tramadol hydrochloride in neonates, born from mothers who underwent analgesia with tramadol for the relief of labour pain.

Methods: Intramuscular tramadol (100--250 mg) was administered to 22 mothers giving birth who requested pain relief. At the time of birth (1.

The incidence of congenital cytomegalovirus infections in The Netherlands.

Cytomegalovirus (CMV) is one of the most common causes of congenital infection without an effective treatment or an effective vaccine available to date. The emphasis has to be on preventive strategies, which rely on the epidemiological situation. The incidence of congenital CMV infections, however, is not known for The Netherlands.

[Malacoplakia of the female genital tract in a woman with postmenopausal bleeding].

A 74-year-old woman had vaginal bleeding for 6 months with no other complaints. A suspected tumour was visible on the cervix and the endometrium was slightly thickened. Histological examination revealed Michaelis-Gutmann bodies.

Use of insulin like growth factor binding protein-1 in the diagnosis of ruptured fetal membranes.

Objective: The benefit of insulin like growth factor binding protein-1 (IGFBP-1) in diagnosing ruptured fetal membranes in cases in which the diagnosis is clinically doubtful, is investigated.

Design: A total of 83 patients with clinically doubtful rupture of fetal membranes were included, and treated as usual. The clinical diagnosis, the amniotic fluid crystallization test, and IGFBP-1 detection were performed on all patients and compared with the defined gold standard.

Ascending dose tolerance study of intramuscular carbetocin administered after normal vaginal birth.

Objective: To determine the maximum tolerated dose (MTD) of carbetocin (a long-acting synthetic analogue of oxytocin), when administered immediately after vaginal delivery at term.

Materials And Methods: Carbetocin was given as an intramuscular injection immediately after the birth of the infant in 45 healthy women with normal singleton pregnancies who delivered vaginally at term. Dosage groups of 15, 30, 50, 75, 100, 125, 150, 175 or 200 microg carbetocin were assigned to blocks of three women according to the continual reassessment method (CRM).

[Puerperal toxic shock syndrome caused by Group A beta-hemolytic streptococci].

This case report describes the history of a young female with a streptococcal toxic shock syndrome secondary to a puerperal sepsis. The syndrome was complicated by severe hypotension, reversible kidney dysfunction, adult respiratory distress syndrome, coagulation disturbances, myositis and rhabdomyolysis. This latter complication required amputation of both lower legs.

Lethal lung hypoplasia in infants after prolonged rupture of membranes.

A retrospective study to detect the frequency of lethal lung hypoplasia in 48 cases with prolonged rupture of membranes (greater than 7 days) before 34 weeks' gestation was made. Fourteen infants died (29%), but only four deaths (8.3%) were due to lung hypoplasia.

First experiences with Swan-Ganz measurements in patients with severe hypertension during pregnancy from an unselected population.

In 10 patients with severe hypertension during pregnancy (6 patients with preexisting hypertension and 4 with severe preeclampsia) Swan-Ganz measurements were done in order to detect and correct a reduced circulating volume and lower the blood pressure. It appeared that 6 patients had a reduced circulating volume (group I) and 4 patients a normal circulating volume (group II). In both groups there were 2 patients with severe preeclampsia; most patients were referred and had antihypertensive medication before and most infants had a birthweight less than the 10th centile.

One-year morbidity in very premature infants: prognostic value of duration of pregnancy, birthweight and neonatal morbidity.

Morbidity in the first year of life of 120 infants, born before the 34th wk of pregnancy, was studied in relationship to both duration of pregnancy and birthweight. Moreover, the interrelationships of morbidity in three time-periods (first-hour, first 28 days and first year after delivery) were studied. The major handicap rate at one year was 5%, without major handicaps in infants born before 29 wk or weighing less than 1250 g.

Survival probabilities of infants delivered prior to the 34th week of pregnancy as estimated by means of a logistic model.

Survival of 188 infants born alive before the 34th wk of pregnancy is assessed in relation both to birthweight and duration of pregnancy. A logistic model is used which describes, based on these parameters, probabilities of 1-yr survival of relatively small populations in a continuous way. Although there may be differences between measured and estimated birthweight, this method might enable the perinatologist to estimate before birth the survival probabilities if he knows the duration of pregnancy and estimated birthweight.