Biomedical subjects

D J Bekedam

Publications and source records attributed to D J Bekedam.

17 recordsLinked to original sources

PubMed2001

Final results of the Cervical Incompetence Prevention Randomized Cerclage Trial (CIPRACT): therapeutic cerclage with bed rest versus bed rest alone.

OBJECTIVE: To compare preterm delivery rates (before 34 weeks of gestation) and neonatal morbidity and mortality in patients with risk factors or symptoms of cervical incompetence managed with therapeutic McDonald cerclage and bed rest versus bed rest alone. STUDY DESIGN: Cervical length was measured in patients with risk factors or symptoms of cervical incompetence. Risk factors for cervical incompetence included previous preterm delivery before 34 weeks of gestation that met clinical criteria for the diagnosis of cervical incompetence, previous preterm premature rupture of membranes before 32 weeks of gestation, history of cold knife conization, diethylstilbestrol exposure, and uterine anomaly. When a cervical length of <25 mm was measured before a gestational age of 27 weeks, a randomization for therapeutic cerclage and bed rest (cerclage group) or bed rest alone (bed rest group) was performed. The analysis is based on intention to treat. RESULTS: Of the 35 women who met the inclusion criteria, 19 were allocated randomly to the cerclage group and 16 to the bed rest group. Both groups were comparable for mean cervical length and mean gestational age at time of randomization, mean overall 20 mm and 21 weeks. Preterm delivery before 34 weeks was significantly more frequent in the bed rest group than in the cerclage group (7 of 16 vs none, respectively; P =.002). There was no statistically significant difference in neonatal survival between the groups (13 neonates survived in the bed rest group vs all in the cerclage group). The compound neonatal morbidity, defined as admission to the neonatal intensive care unit or neonatal death, was significantly higher in the bed rest group than in the cerclage group (8 of 16 vs 1 of 19, respectively; P =.005; RR = 9.5, 95% CI, 1.3-68.1). CONCLUSIONS: Therapeutic cerclage with bed rest reduces preterm delivery before 34 weeks of gestation and compound neonatal morbidity in women with risk factors and/or symptoms of cervical incompetence and a cervical length of <25 mm before 27 weeks of gestation.

Bed Rest↗

PubMed2000

Cervical incompetence prevention randomized cerclage trial (CIPRACT): study design and preliminary results.

OBJECTIVE: The objective of this study was to compare different management strategies for women at risk for cervical incompetence. STUDY DESIGN: In an ongoing randomized trial patients with a previous preterm delivery at <34 weeks' gestation who met clinical criteria for the diagnosis of cervical incompetence are allocated to receive a prophylactic cerclage (prophylactic cerclage group) or not (observational group) in a proportion of 1:2. Transvaginal ultrasonographic follow-up examination of the cervix is performed in both groups. When a patient of the latter group has a cervical length <25 mm at <27 weeks' gestation, a further random assignment of therapeutic cerclage or no cerclage is performed. The analysis is by intent to treat. RESULTS: Primary random assignment allocated 23 women to the prophylactic cerclage group and 44 to the observational group. Both groups were comparable with respect to obstetric history. No significant difference was found between the prophylactic cerclage group and the observational group in preterm delivery at <34 weeks' gestation (3/23 vs 6/44, respectively) and neonatal survival (21/23 vs 41/44, respectively). A cervical length <25 mm was found in 18 patients (41%) in the observational group at a mean gestational age of 19.1 +/- 2.9 weeks' gestation. Incidence of preterm delivery at <34 weeks' gestation was significantly higher in the group with short cervical length (6/18 vs 0/26; P =.003). Secondary random assignment of the 18 patients with short cervical length allocated 10 to undergo therapeutic cerclage. Preterm delivery at <34 weeks' gestation was significantly less frequent in the therapeutic cerclage group (1/10 vs 5/8). CONCLUSION: Transvaginal ultrasonographic serial follow-up examinations of the cervix in women at risk for cervical incompetence, with secondary intervention as indicated, appears to be a safe alternative to the traditional prophylactic cerclage. Transvaginal ultrasonographic follow-up examination of the cervix can save the majority of women from unnecessary intervention. Placement of a therapeutic cerclage may reduce the incidence of preterm delivery at <34 weeks' gestation among high-risk patients.

Cervix Uteri↗

PubMed1998

The prevalence of type 2 diabetes and gestational diabetes mellitus in an inner city multi-ethnic population.

Zeeburg', a multiethnic town borough in the Amsterdam-East region, has one of the city's highest rates of immigrants. In the total population of 19,825 Surinam (mainly Creole), Turkish, Moroccan, and Dutch adults the prevalence of known type 2 diabetes in 1994 and of gestational diabetes mellitus (GDM) between January 1992 and January 1997 was investigated. Based on World Health Organization (WHO) criteria of 1985, the age-standardized prevalence of type 2 diabetes was similar in men (6.4%; 95% confidence interval [CI]: 5.6-7.2) and women (6.4%: 95% CI: 5.8-7.0) for all ethnic groups combined. However, the age- and sex-standardized prevalence of type 2 diabetes was significantly greater in the non-Dutch inhabitants than in the Dutch inhabitants (17.3% [95% CI: 12.9-21.6] in Surinam inhabitants, 10.9% [95% CI: 9.7-12.2] in Turkish inhabitants, 12.4% [95% CI: 9.7-15.0] in Moroccan inhabitants, and 3.6% [95% CI: 3.2-3.9] in Dutch inhabitants). The odds ratios for type 2 diabetes for the separate immigrant groups relative to the Dutch group were 5.88 (95% CI: 4.54-7.69) for Surinam inhabitants, 4.00 (95% CI: 2.86-5.55) for Turkish inhabitants, and 4.17 (95% CI: 3.03-5.55) for Moroccan inhabitants. GDM was present in 2.59% of women of non-Dutch origin compared with 0.62% of women of Dutch origin. A significant positive association was found between the non-Dutch origin and the occurrence of GDM (chi2 = 6.7; p < 0.01). The study highlights a high prevalence of known type 2 diabetes and GDM in the immigrant inhabitants and emphasizes that appropriate interventions are necessarily with implications for health targets and capitation based budgets.

Adult↗

PubMed1995

Prenatal diagnosis in two cases of de novo complex balanced chromosomal rearrangements. Three-year follow-up in one case.

We report two cases of apparently balanced complex de novo chromosomal rearrangements (BCCR) detected prenatally at 17 weeks and 10 weeks of gestation, respectively. Chromosomes were studied using GTG-banding and fluorescent in situ hybridization (FISH). In one case four chromosomes and in the other case three chromosomes were involved in the rearrangements. One of the pregnancies was terminated and no external or internal showed no abnormalities. The child is now 3 years old and has neither congenital anomalies nor evidence of delayed psychomotor development.

Adult↗

PubMed1993

Qualitative abnormal fetal breathing movements, associated with tracheal atresia.

A case is reported in which qualitatively, grossly abnormal fetal breathing movements turned out to be indicative of complete tracheal atresia. Fetal breathing movements were vigorous and jerky and of large amplitude; similarly abnormal movements were observed after birth. At postmortem tracheal atresia was diagnosed, in combination with other congenital abnormalities, which pointed to a VATER-association. The combination of a VATER-association with tracheal atresia has only been reported once before. An absence of the normal Hering-Breuer reflex in this case of complete tracheal atresia, probably explains the abnormal fetal breathing pattern. This case is in line with a growing number of reports in literature in which qualitatively abnormal fetal movements were indicative of congenital malformations.

Abnormalities, Multiple↗

PubMed1991

The effects of maternal hyperoxia on fetal breathing movements, body movements and heart rate variation in growth retarded fetuses.

In hypoxemic intrauterine growth-retarded fetuses (IUGR) there is a reduction in the incidence of fetal movements and in fetal heart rate variation. A causal relationship with the impairment of fetal oxygenation has been suggested. In 16 IUGR fetuses and in 13 normally grown fetuses maternal hyperoxygenation was applied for 40 min to increase fetal PO2 levels. All IUGR fetuses had abnormal Doppler blood velocity waveforms of the umbilical artery suggesting an impaired uteroplacental exchange. The effect of hyperoxygenation on fetal breathing and body movements and on fetal heart rate was evaluated. In the IUGR fetuses there was a significant increase in fetal breathing and body movements and in heart rate variation during hyperoxygenation as compared to the preceding control period of 40 min. No significant changes in fetal breathing and body movements were found in the normally grown control fetuses. A surprising observation was the increase of the number of heart rate decelerations after discontinuation of the maternal hyperoxygenation. It is concluded that in IUGR fetuses the increase in fetal heart rate variation and the increase in the incidence of breathing and body movements during maternal hyperoxygenation substantiates the relationship between these variables and the oxygenation status of the fetus.

Female↗

PubMed1990

Changes in antepartum heart rate patterns with progressive deterioration of the fetal condition.

In this paper changes in antepartum fetal heart rate (FHR) patterns are described, that occur with progressive deterioration of the fetal condition. The data on the relationship between heart rate patterns and fetal blood gas and pH values are reviewed. A possible rank ordering is presented in which changes in FHR pattern, body movements and blood flow velocity wave form patterns occur with progressive deterioration of the fetal condition. It is concluded that in small-for-date fetuses changes in heart rate and movement patterns are rather late signs of impairment, coinciding with fetal hypoxaemia. In general, heart rate variation falls below the norm at the same time as decelerations occur; there are, however, large inter-fetal differences. In general, abnormal Doppler velocity wave form patterns precede the occurrence of heart rate decelerations. Their impact on the timing of delivery is, however, still uncertain. The advantages of a numerical analysis of FHR patterns include identification of fetuses with low FHR variation, precision of the actual fetal condition and (at early gestation) longitudinal follow-up of fetuses with abnormal heart rate patterns.

Animals↗

PubMed1990

Abnormal velocity waveforms of the umbilical artery in growth retarded fetuses: relationship to antepartum late heart rate decelerations and outcome.

In 70 intrauterine growth-retarded (IUGR) fetuses with antepartum late heart rate decelerations recordings of velocity waveforms of the umbilical artery were made with Doppler ultrasound and calculated as pulsatility indexes (PI). In 29 of these fetuses longitudinal recordings were made. Abnormal PIs preceded the occurrence of late heart rate decelerations in 27 (93%) of the 29 fetuses. The median duration of the interval between the first abnormal PI and the first appearance of antenatal heart rate decelerations was 17 days (range 0-60 days). This wide range can mainly be attributed to the gestational age at which the first abnormal velocity wave-form was recorded; during early gestation the interval was much longer than later in pregnancy. Absent end-diastolic velocity (AEDV) was found in 17 of the 29 fetuses (59%) and preceded the occurrence of decelerations with a median interval of 12 days. In the total group, 4 of the 70 IUGR fetuses with antepartum decelerations had a normal velocity waveform of the umbilical artery. Fetuses with AEDV (n = 45) were more severely growth retarded and were delivered at an earlier gestational age than those with end-diastolic velocity (n = 25). Also perinatal mortality and morbidity were higher in the group with AEDV. Yet, when fetuses were matched for gestational age and birth weight no differences in perinatal outcome were found in the groups with and without end-diastolic velocity.

Adult↗

PubMed1989

The effect of (induced) maternal emotions on fetal behaviour: a controlled study.

In ten healthy near-term pregnant women the effect of induced maternal emotions on fetal motor behaviour was studied. Emotions were induced by showing a film of a normal delivery. Fetal behaviour was recorded by means of real-time ultrasound observations of general movements and eye movements and by fetal heart rate monitoring. The observations had a duration of 2 h. The data were compared with those obtained during a 2-h control period, which took place the day before (n = 5) or after the study period (n = 5). Maternal emotions (induced) were measured by means of psychological tests. No effects on fetal motor activity or on behavioural state organization could be found as a result of this film. There was, however, a significant positive correlation (P less than 0.01) between the mean level of anxiety of the women and the motor activity of the fetuses.

Adult↗

PubMed1987

Emergence of behavioural states in fetuses of type-1-diabetic women.

The aim of this study was to investigate the effects of tightly controlled maternal (type-1-)diabetes mellitus on the development of fetal behavioural states. Seventeen diabetic women, who required insulin (White's class C predominantly) and were treated with continuous subcutaneous insulin infusion (CSII) therapy, participated in the study. Adjustment to an insulin-pump occurred before conception or during early pregnancy. In all diabetic women (near-)normoglycemia was achieved during pregnancy, with glycosylated hemoglobin-values within the normal range (6-8.5%). Fifty-three 2-h recordings of fetal heart rate, uterine contractions and of real-time ultrasound scanning for fetal body movements, breathing and eye movements were obtained from the 17 fetuses. The fetuses were longitudinally studied between 32 and 40 weeks post menstrual age, at intervals of 2 weeks. The 3 state variables, fetal heart rate, body movements and eye movements, were analyzed for the presence of combinations meeting the definitions of the four fetal behavioural states. Findings in the fetuses of diabetic women were compared with those obtained from 28 low risk fetuses. The criteria of states were met in only 3 of 8 fetuses studied at 38 weeks and in one of two studied at 40 weeks. For comparison: in low risk fetuses studied at 38 and 40 weeks, states were present in 70% and 90% of the cases, respectively. This poorly developed state organization exhibited by the near term fetuses of the diabetic group, was related to maternal parity, but not to pre- or postconceptional onset of CSII-treatment. Fetuses of nulliparous diabetic women showed more often asynchrony of transitions (greater than 3 min) and interruption of periods of concordant association. This resulted in significantly higher percentages of 'no-coincidence' and in low incidence of behavioural states as compared with control fetuses of nulliparous women. In the few multiparous diabetic cases studied near term the development of fetal behavioural states was normal. We conclude therefore that, despite tight control of maternal diabetes, the development of behavioural states is disturbed in fetuses of nulliparous diabetic women.

Adult↗

PubMed1987

Heart rate variation and movement incidence in growth-retarded fetuses: the significance of antenatal late heart rate decelerations.

In 37 intrauterine growth-retarded fetuses, combined 1-hour recordings of fetal heart rate and body movements were made within 24 hours of elective cesarean section. Fetal body movements were recorded simultaneously by use of real-time ultrasound. The study group was divided into two subgroups, according to the presence (n = 29) or absence (n = 8) of antepartum late heart rate decelerations. Correlations were made with umbilical blood gas values obtained immediately after cesarean section. Baseline heart rate variation was reduced below the normal range in 88% of the intrauterine growth-retarded fetuses with decelerations but in only 37% of the group without decelerations. A reduction in fetal heart rate accelerations and body movements and an increase in mean heart rate also were observed only in the group with decelerations. Late heart rate decelerations were associated with low PO2 values in both umbilical artery and vein. It is concluded that in intrauterine growth-retarded fetuses reduced heart rate variation and movement incidence correlate with the presence of late heart rate decelerations before birth and with hypoxemia at birth.

Cesarean Section↗

PubMed1987

Fetal behavior at 30 to 32 weeks of gestation.

Coordinated behavior states with concomitant variation in cyclic patterns of heart rate and of eye and gross body movements are present in the near term fetus. As in the newborn infant, there is conflicting evidence concerning their relationship at earlier gestational ages. In the present study 120-min recordings were made of fetal heart rate, eye, and gross body movements in 11 healthy nulliparous women who were 30 to 32 wk pregnant. From the presented data it is concluded that at this gestational age heart rate variation and eye and gross body movements are not independent variables and that coordination among the cyclic patterns of these variables starts well before 36 wk.

Behavior↗

PubMed1986

Fetal behaviour in type-1 diabetic women.

Real-time ultrasound observation of fetal movement patterns can be used to assess the development of the motor component of the nervous system. Data are presented on the emergence of fetal movements in the first trimester of pregnancy, and on the development of fetal behavioural states in the third trimester, in women with type-1 (insulin dependent) diabetes. In the first trimester there is a delay in emergence of movement patterns. This delay is, however, not specific but parallels that of growth. In the third trimester there is a delay in emergence of fetal behavioural states. It is concluded that a tight metabolic control, achieved with continuous insulin infusion, does not prevent these disturbances in development.

Diabetes Mellitus, Type 1↗

PubMed1985

Effects of hypoxemic events on breathing, body movements, and heart rate variation: a study in growth-retarded human fetuses.

In 14 growth-retarded human fetuses, breathing and body movements were studied before, during, and after late heart rate decelerations. Heart rate variation was measured before and after the decelerations. Breathing and body movements were significantly reduced during and after the deceleration. Heart rate variation was reduced after the decelerative episode. Since late heart rate decelerations are presumably signs of acute fetal hypoxemia, there is evidence that these reductions are caused by hypoxemia. The results suggest, furthermore, that just as in fetal sheep, these changes might be mediated by a change in brain activity state.

Female↗

PubMed1985

Motor behaviour in the growth retarded fetus.

In ten growth retarded fetuses (IUGR) a qualitative and quantitative analysis was made of various movement patterns. The results were compared with those of ten matched appropriate-for-gestational age fetuses (AGA). The aim of the study was to see whether malnourished, growth retarded fetuses move differently to well nourished, normal fetuses. The real-time ultrasound recordings were of one hour's duration and the analysis of motility was carried out during replay of video recordings. The qualitative analysis of each separate general movement was performed with 'Gestalt perception' describing the speed, force and amplitude of each movement as well as the variability of these descriptors. Interobserver agreement was evaluated by displaying general movements of both groups to 8 observers. There was an overall interobserver agreement of 89%. The IUGR fetuses moved less, but in individual cases an overlap existed with control fetuses. There was a reduction of both number and duration of general movements in the IUGR group. Furthermore the markedly reduced incidence of startles, twitches and isolated limb movements was striking. The qualitative analysis of general movements revealed a reduction of the quicker components leading to slow and monotonous movement patterns. There was also a marked reduction of variability of speed and intensity within each movement pattern. We speculate that the reduced variability of motor patterns may find its origin in a change of central neural function, just as the reduced heart rate variability and decreased breathing irregularity found in IUGR fetuses.

Adult↗

PubMed1985

Delayed emergence of fetal behaviour in type-1 diabetic women.

In pregnancies complicated by maternal type-1 diabetes early fetal growth delay is common and it is suggested that there might be a common mechanism behind this growth delay and the induction of abnormal embryogenesis. As some of the most frequent congenital malformations involve the nervous system, the following study was performed in order to determine whether there is a specific delay in development of neural activity in these embryos and fetuses. In ten women with type-1 diabetes the emergence of specific fetal movement patterns, which are an expression of the functional motor development of the nervous system, was studied weekly by 1 h real-time ultrasound observations, starting at or before 8 weeks of gestation. Data were compared with those obtained in uncomplicated pregnancies. In all women a tight metabolic control was achieved with continuous subcutaneous insulin infusion. In six patients this treatment was started before conception. In all but one of the movement patterns emerging in the first 12 weeks of gestation a delay of 1-2 weeks was found in their first appearance. Only breathing movements were observed for the first time at the same gestational age as in the control group. Plotted according to crown-rump length the emergence of fetal movement patterns occurred, however, almost at the same time as in the control group. It is concluded, that in well controlled diabetic pregnancy there is a delay in functional motor development of the embryonic and fetal nervous system; this delay is not very specific but mostly parallels that of growth; breathing movements emerge relatively early as compared to growth.

Adult↗

PubMed1985

Abnormal motor behaviour in anencephalic fetuses.

In eight anencephalic fetuses ultrasound observations of movement patterns were made and correlated with the morphological findings at postmortem. In all fetuses the movements were qualitatively abnormal: they were forceful, jerky in character and of large amplitude. In some of the most defective cases classification of the movements was hardly possible as they showed little similarity to those observed in normal fetuses. In these cases movements tended to occur in burst-pause patterns in contrast to being scattered over the record. Excessive activity occurred also only in the more defective cases. In fetuses with no evident cervical cord present isolated arm movements were observed. Fetal lung hypoplasia occurred as early as 16 weeks and in a fetus which showed both hiccups and breathing movements. It is concluded that with a severely defective fetal central nervous system, already in the first half of pregnancy movement patterns are abnormal. This abnormality mainly concerns the quality of the different movements. Secondly, movements can occur despite severe reduction in the amount and alteration in the organisation of the fetal central nervous system.

Anencephaly↗