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Biomedical subjects

G Kleiverda

Publications and source records attributed to G Kleiverda.

13 recordsLinked to original sources

[First trimester medical abortion: a good method that is seldom used in The Netherlands].

A majority of Dutch women present their request for termination of pregnancy very early after their missed period. For these women, medical abortion with mifepriston and misoprostol is a good option. The method is only rarely used in The Netherlands. A change in attitude of the care-providers, dissemination of information to women and new legislation is needed to increase the use of this non-invasive treatment, which has proven to be safe up to 9 weeks in the home situation.

Abortifacient Agents, Nonsteroidal↗

Symptom perception: psychological correlates of symptom reporting and illness behavior of women with medically unexplained gynecological symptoms.

Medically unexplained (gynecological) symptoms can be viewed as an indication of the somatization of negative emotions. Most studies regarding psychological correlates of medically unexplained gynecological symptoms have paid attention only to certain personality characteristics of women with these symptoms. In this study the reporting of physical symptoms and the resulting illness behavior is explained in terms of information processing or a perception process, i.e. the process by which people detect and interpret physical sensations as symptoms of illness (symptom perception). Symptom perception is in part determined by environmental characteristics and cognitive and emotional processes, such as variation in daily life, (coping with) emotional threat and the use of cognitive illness schemes. Differences in symptom perception and illness behavior of women with medically unexplained and explained gynecological symptoms, compared to women with medically explained gynecological symptoms and a control group, were established with the help of a questionnaire, containing a number of scales. As expected, women with medically unexplained gynecological symptoms had higher reports of common symptoms and sensations and showed also more other illness behavior than the other two groups. They reported less variation and more threat in daily life than the other two groups. These variables together with the use of illness schemes contributed most to symptom reporting of women with medically unexplained symptoms. It is concluded that defence against threat is probably an important determinant. Suggestions for further research and some practical implications are discussed.

Adolescent↗

Place of delivery in The Netherlands: actual location of confinement.

Preferred and actual locations of confinement were compared in a group of 170 nulliparous women. Voluntary changes in preferred location for birth were rare and concerned only changes from hospital to home confinement. Obligatory changes due to referral to consultant obstetricians occurred frequently: 58.8% of the total sample. Fewer referrals were found for women with an initial preference for a home confinement (53%) than for those who preferred a hospital confinement (64%). Most referrals occurred in the group of older women initially in doubt about their preferred location for giving birth: 72%. The differences were not significant, however. To reveal differences between referrals and non-referrals, discriminant analysis was performed at the 18th week of gestation. The explained variance for the total group of referrals was 64.7%. Partially, the variables pertaining to the explained variance were the same as those related to a preferred hospital confinement. The explained variance for the group of referrals in which psychosocial influences were presupposed was not better, with the exception of referrals due to insufficient progress during labour: 76.4% of the variance could be explained at the 34th gestational week. When birth weight and amenorrhoea were included, these percentages increased to 79.0 and 84.8%, respectively.

Adult↗

Umbilical vein administration of oxytocin for the management of retained placenta: is it effective?

In a multicenter randomized controlled trial involving 220 women with retained placenta no beneficial effects could be established of intraumbilical vein administration of 10 IU of oxytocin in 20 ml of saline solution. A reduction was not gained in the rate of manual removal of the placenta and there was no decrease in the amount of blood loss. Oxytocin only induced a minor shortening of the median time interval from administration to the spontaneous expulsion of the placenta as compared with a placebo injection. Maternal serum alpha-fetoprotein levels before and after intraumbilical vein injection did not show evidence of fetomaternal transfusion.

Adult↗

Severe asphyxia and outcome of survivors.

Fifty-four infants born severely asphyxiated with birth weights of more than 2500 g and gestational ages older than 37 weeks were studied with help of careful review of the case files. To establish a relationship between the time elapsed after birth to spontaneous regular active respiration and later outcome, the infants were divided into three groups: group A of 34 children, established spontaneous active respiration within 15 min; group B of 7 children recovered in 15-30 min, and group C of 13 children recovered 30 min after birth. The outcome in group C, in which the infants also had a history of prolonged intrapartum asphyxia, was uniformly bad. The absence or presence of an audible heart beat at birth was not a reliable clinical sign for a prognosis. The time that elapsed between the start of resuscitation and the first gasp had to be doubled to indicate the likely start of regular active respiration in one third of our babies. The results indicated that the combination of prolonged intrapartum asphyxia and a delay in onset of spontaneous regular respiration of more than 30 min following birth predicted a uniformly bad prognosis. Attempts at resuscitation after this interval did not appear to be warranted.

Acid-Base Equilibrium↗

Place of delivery in The Netherlands: maternal motives and background variables related to preferences for home or hospital confinement.

The decision-making process regarding the preferred site for confinement was investigated in a total of 170 nulliparous women with initially uncomplicated pregnancies. Of these women, 100 had a preference for delivery at home and 45 for hospital confinement. The remaining 25 women were in doubt about the preferred location. Interviews were held at the 18th week of pregnancy. Motives for choosing either a home or a hospital confinement were analysed. Preferences for either home or hospital confinement were predicted by a stepwise discriminant analysis. Educational level, psychological well-being, anxiety concerning complications at birth, and attitudes towards female social roles accounted for 78.6% of the variance. Fear that something might go wrong during labour together with an older age predicted for 62% the group of women doubtful about the place of confinement.

Delivery, Obstetric↗