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Biomedical subjects

Gerard H A Visser

Publications and source records attributed to Gerard H A Visser.

At least 19 recordsLinked to original sources
PubMed2006

Occurrence of ST-changes recorded with the STAN S21-monitor during normal and abnormal fetal heart rate patterns during labour.

OBJECTIVE: To determine the frequency of ST-changes in the fetal electrocardiogram (ECG) both during normal and abnormal fetal heart (FHR) traces and to study relations with characteristics of pregnancy and delivery. STUDY DESIGN: Retrospective analysis of 563 FHR+ECG-recordings. ST-changes were counted for all recordings with respect to their FHR pattern. Relationships between the occurrence of ST-events and characteristics of pregnancy and delivery were determined for the recordings with a completely normal FHR tracing during the first stage. RESULTS: ST-events were present during 51.7% of recordings in the first stage of labour and during 24.3% of the recordings in the second stage. Surprisingly, events occurred during the first stage at a similar incidence during normal and abnormal FHR-patterns. During the second stage of labour events also occurred in a similar percentage of normal, intermediary and abnormal recordings, but - if present - events were more numerous during the abnormal FHR traces. In the subgroup of cases with a normal FHR pattern more events per hour occurred in babies born at 36-37 weeks of gestation and in boys. CONCLUSION: ST-events are a frequent finding during normal FHR tracings.

Birth Weight↗
PubMed2006

Does maternal prenatal stress adversely affect the child's learning and memory at age six?

Prenatal maternal stress has been shown to affect postnatal development in animals and humans. In animals, the morphology and function of the offspring's hippocampus is negatively affected by prenatal maternal stress. The present study prospectively investigated the influence of prenatal maternal stress on learning and memory of 112 children (50 boys, 62 girls, Age: M=6.7 years, SD=8.4 months), with the Test of Memory and Learning (TOMAL). Maternal stress levels were determined three times during pregnancy by self-report questionnaires. Furthermore, maternal saliva cortisol samples were used as a measure of hypothalamus-pituitary-adrenal axis functioning. Results of hierarchical multivariate regression analyses showed that maternal life events measured during the first part of pregnancy were negatively associated with the child's attention/concentration index, while controlling for overall IQ, gender, and postnatal stress. No associations were found between prenatal maternal cortisol and the offspring's learning and memory.

Adult↗
PubMed2006

Differences in behavioral outcome and motor development at school age after neonatal treatment for chronic lung disease with dexamethasone versus hydrocortisone.

Neonatal dexamethasone (DEX) for chronic lung disease is associated with adverse outcome. We compared behavioral and motor development at school age of children who neonatally received DEX to children neonatally treated with hydrocortisone (HC) in a retrospective matched cohort study. DEX- and HC-treated groups matched for gestational age, birth weight and year, gender, and severity of respiratory distress syndrome were compared with a reference group (REF) and a group treated only antenatally with betamethasone (BMETH). REF and BMETH groups had a higher gestational age and less severe respiratory distress syndrome. From 192 children (DEX, n = 46; HC, n = 52; REF, n = 43; BMETH, n = 51), the Child Behavioral Checklists from parents and teachers (Teacher's Report Form) and the Movement Assessment Battery for Children to assess neuromotor function were analyzed. DEX girls had a poorer performance on nearly all behavioral scales of the Teacher's Report Form compared with HC girls. DEX boys did not differ from HC boys. The HC boys or girls did not differ from the REF or BMETH groups. Neuromotor development was poorer in DEX than the BMETH and REF groups. The HC group did not differ from REF and BMETH groups. We suggest that neonatal HC may be a "safer" alternative for DEX for the treatment of CLD.

Anti-Inflammatory Agents↗
PubMed2006

Obstetric management and outcome of pregnancy in women with a history of caesarean section in the Netherlands.

OBJECTIVE: To determine mode of delivery and occurrence of uterine rupture in women with a previous caesarean section (CS) in the Netherlands. MATERIALS AND METHODS: During a 1-year period 38 hospitals in the Netherlands registered prospectively mode of delivery, use of prostaglandins or oxytocin and occurrence of uterine rupture in all women with a previous CS. RESULTS: There were 4569 women with a previous CS. Trial of labour (TOL) was attempted in 71.7%, of whom 76.0% delivered vaginally. The vaginal birth after caesarean (VBAC)-rate was 54.4%. Forty-nine uterine ruptures occurred (1.1%), of which 48 occurred during a TOL (1.5%). There were four perinatal deaths (1.2/1000 TOL) and 3 hysterectomies (0.9/1000 TOL) related to the rupture. Use of prostaglandin E2 alone or combined with oxytocin was significantly associated with an increased risk of uterine rupture (OR 6.8, 95% CI 3.2-14.3, OR 4.8, 95% CI 1.6-14.6, respectively). The same held for augmentation with oxytocin (OR 2.2, 95% CI 1.04-5.0). CONCLUSION: The success rate of TOL was 76%, resulting in a VBAC rate of 54%. Uterine rupture occurred in 1.5% during a TOL, with a risk of perinatal death of 1.2 per 1000. The risk of uterine rupture increased significantly when labour was induced with prostaglandins alone or combined with oxytocin or when labour was augmented with oxytocin.

Dinoprostone↗
PubMed2006

Uterine rupture and its complications in the Netherlands: a prospective study.

OBJECTIVE: To determine maternal and perinatal morbidity and mortality after uterine rupture in the Netherlands. STUDY DESIGN: All 100 Dutch obstetric departments were asked to participate in a prospective nationwide registration of uterine rupture between 1st April 2002 and 1st April 2003. For every case, a questionnaire about obstetrical history, current pregnancy and delivery, maternal and neonatal outcome was completed. RESULTS: Eighty-nine percent of all hospitals in the Netherlands participated. Ninety-eight uterine ruptures were registered; 95 after a previous caesarean section (CS) of which 91 occurred during a trial of labour. The fetus was extruded in the abdominal cavity completely in 18 cases and partially in 13 cases. Major complications due to uterine rupture were: perinatal death (n=11, from 94 cases with a viable fetus, 11.7%) and hysterectomy (n=4, 4.1%). CONCLUSION: These severe complications, perinatal death and hysterectomy, have to be an issue when counselling women on an elective CS and women with a history of a CS on the route of delivery.

Cesarean Section↗
PubMed2006

The umbilical coiling index in complicated pregnancy.

OBJECTIVE: To evaluate umbilical cord coiling in pregnancies with adverse outcome. STUDY DESIGN: Umbilical cords and hospital records of 565 consecutive cases with an indication for histological examination of the placenta were studied. The umbilical coiling index (UCI) was determined as the number of complete coils divided by the length of the cord in centimeters, by an observer blinded for pregnancy outcome. Data on obstetric history and pregnancy outcome of each case were obtained from the hospital records. We calculated odds ratios and their 95% confidence interval to evaluate the strength of associations between pregnancy outcome and abnormal cord coiling. RESULTS: Fetal death (OR 4.09, 95% CI 2.22-7.55), chorioamnionitis (OR 1.77, 95% CI 1.09-2.88), fetal structural or chromosomal abnormalities (OR 1.78, 95% CI 1.08-2.95), and lower Apgar score at 5 min (p=0.03) were associated with undercoiling (UCI below the 10th percentile, using reference values from uncomplicated pregnancies). Fetal death (OR 3.74, 95% CI 1.89-7.40), iatrogenic preterm delivery (OR 1.91, 95% CI 1.04-3.49), umbilical arterial pH<7.05 (OR 3.63, 95% CI 1.44-9.17), fetal structural or chromosomal abnormalities (OR 1.79, 95% CI 1.01-3.16), thrombosis in fetal placental vessels (OR 2.64, 95% CI 1.37-5.06), chronic fetal hypoxia/ischemia (OR 1.82, 95% CI 1.09-3.05), and lower weight for gestational age (p=0.01) were associated with overcoiling (UCI above the 90th percentile). CONCLUSIONS: Our findings confirm that adverse perinatal outcome is associated with both undercoiling and overcoiling of the umbilical cord.

Adult↗
PubMed2006

Forty-eight-hour first-trimester glucose profiles in women with type 1 diabetes mellitus: a report of three cases of congenital malformation.

OBJECTIVE: Despite modern methods of treatment and near-normal HbA(1c) levels, women with type 1 diabetes mellitus are still at risk of having an infant with a congenital malformation (CM). We hypothesised that HbA(1c) levels are too gross a measure of glycaemic control and used a continuous glucose monitoring system (CGMS) to determine the diurnal glucose profiles during the first trimester of pregnancy. We present three cases of infants with a CM. METHODS: Fifty-three women with type 1 diabetes used the CGMS for 48 h in the first trimester of pregnancy. Three of them gave birth to infants with a CM. HbA(1c) levels were determined at the time of the CGMS measurement and 6 to 8 weeks later. RESULTS: The HbA(1c) levels at the time of the CGMS measurement were 6.0, 6.5 and 7.8% (normal range 4.0-6.0%) in the three women. The 48-h diurnal glucose profiles of these women showed a large variability with frequent hyperglycaemic episodes. CONCLUSIONS: HbA(1c) levels are too gross a measure of glycaemic control to identify women at risk of giving birth to an infant with a CM. Even in women with normal or near-normal HbA(1c) levels, the diurnal glucose profiles reveal intermittent hyperglycaemic episodes that may cause the CM.

Adult↗
PubMed2006

Is there a diurnal pattern in the clinical symptoms of HELLP syndrome?

OBJECTIVE: To determine if there is a diurnal pattern in the clinical symptoms of HELLP (Hemolysis, Elevated Liver enzymes, Low Platelets) syndrome. STUDY DESIGN: A retrospective study was performed in 134 pregnancies complicated by HELLP syndrome. The medical records were reviewed to describe each HELLP episode. Time of day was divided into three periods, day, evening, and night. The following parameters were categorized according to the time of day: onset of symptoms, consultation by the doctor, initial blood sampling, diagnosis and decrease of symptoms. Biochemical parameters at clinical presentation and consecutive changes within 24 h were recorded. RESULTS: In 65 pregnancies 77 HELLP episodes were well documented. Times of onset of symptoms and consultation by the doctor were significantly higher during the evening and night (p < 0.001), whereas times of diagnosis and decrease of symptoms occurred significantly more during the day (p < 0.001). In only 49.3% of the cases were diagnostic laboratory criteria met at clinical presentation. This was mainly due to platelet values in excess of 100 x 10(9)/l. Several hours later (median 8 h, range 2-23) the decrease in platelets occurred. CONCLUSIONS: A diurnal pattern exists in the clinical symptoms of HELLP syndrome that is characterized by an exacerbation during the night and recovery during the day. There is a considerable delay between the onset of symptoms and the fulfillment of diagnostic laboratory criteria.

Adolescent↗
PubMed2006

Umbilical coiling index in normal and complicated pregnancies.

OBJECTIVE: To estimate the relation between undercoiling and overcoiling of the umbilical cord and adverse pregnancy outcome. METHODS: Umbilical cords and hospital records of 885 patients were studied in a cross-sectional study design. The umbilical coiling index was determined as the number of complete coils divided by the length of the cord in centimeters, blinded for pregnancy outcome. Obstetric history and pregnancy outcome of each patient were obtained from hospital records, blinded for the umbilical coiling index. Odds ratios and their 95% confidence intervals were calculated to evaluate associations between undercoiling and overcoiling and adverse pregnancy outcome, using multiple logistic regression. RESULTS: Undercoiling (umbilical coiling index below the 10th percentile, using references values from uncomplicated pregnancies) was associated with fetal death (odds ratio [OR] 3.35, 95% confidence interval [CI] 1.48-7.63), spontaneous preterm delivery (OR 2.16, 95% CI 1.34-3.48), trisomies (OR 5.79, 95% CI 2.07-16.24), low Apgar score at 5 minutes (OR 3.14, 95% CI 1.47-6.70), velamentous cord insertion (OR 3.00, 95% CI 1.16-7.76), single umbilical artery (OR 3.68, 95% CI 1.26-10.79), and dextral coiling (OR 1.80, 95% CI 1.02-3.17). Overcoiling (umbilical coiling index above the 90th percentile) was associated with asphyxia (OR 4.16, 95% CI 1.30-13.36), umbilical arterial pH < 7.05 (OR 2.91, 95% CI 1.05-8.09), small for gestational age infants (OR 2.10, 95% CI 1.01-4.36), trisomies (OR 9.26, 95% CI 2.84-30.2), single umbilical artery (OR 8.25, 95% CI 2.60-26.12), and sinistral coiling (OR 4.30, 95% CI 1.52-12.2). CONCLUSION: Undercoiling and overcoiling of the umbilical cord are associated with increased risk for adverse perinatal outcome.

Adult↗
PubMed2006

The natural course of monochorionic and dichorionic twin pregnancies: a historical cohort.

Current early diagnosis, surveillance and intervention options make it hard to determine the natural course of twin pregnancies, especially regarding spontaneous preterm delivery and perinatal mortality. We studied the natural course in monochorionic (MC) and dichorionic (DC) twin pregnancies in a historical cohort. Twin pregnancies were studied in a unique database of 651 twin pairs born in the period 1907 to 1938. We examined the effect of chorionicity on gestational age, birthweight, perinatal mortality, intertwin birthweight differences, the incidence of preeclampsia and maternal mortality. Perinatal mortality was 27.7% for MC and 15.8% for DC twins (p < .001). Gestational age and birthweight were stronger predictors of perinatal mortality than chorionicity. Perinatal outcome was poorer for the second twin, especially in DC twins. Delivery before 37 weeks of gestation occurred more often in MC twin pregnancies (48.8% compared to 33.3% in DC twin pregnancies). DC twins were on average 288 g (95% confidence interval 201-376) heavier than MC twins. Severe birthweight discordancy occurred equally in MC and DC twins (18.1%). However, if present, mortality was only increased in MC twins. The birthweight of girls was not affected by the presence of a male co-twin. In this historical cohort MC twin pregnancies had a higher perinatal mortality, caused by a high incidence of low birthweight mainly due to preterm delivery. Mortality did not differ in deliveries after 31 weeks of gestation, which is in contrast to recent data. Apparently, modern obstetrics is more effective in reducing mortality in DC twins.

Adult↗
PubMed2005

Lipoprotein (a) in pregnancy: a critical review of the literature.

In this article the literature on lipoprotein (a) during normal pregnancy and pregnancy complicated by preeclampsia or intrauterine growth restriction is reviewed. MEDLINE, from January 1966 to May 2003, was searched to locate relevant articles in English. Additional publications were identified by reviewing references in selected articles. Studies were reviewed by predefined and strict criteria. It appeared that methodology and results of studies on lipoprotein (a) during normal and complicated pregnancy were very diverse. Lipoprotein (a) increased with advancing gestation or remained unaltered during normal pregnancy. Women with preeclampsia had higher, unaltered or lower lipoprotein (a) concentrations as compared to normal pregnant controls. Only few studies were in agreement with most of the review criteria. In conclusion, published studies on lipoprotein (a) in pregnancy differ substantially in the used methods to measure lipoprotein (a), sample size, study design and ethnicity of the study population. Therefore, these studies yielded conflicting results and no unequivocal view on the role of lipoprotein (a) in normal and complicated pregnancy. Recommendations for future studies are amongst others: the use of an apo(a) independent method for measuring Lp(a), inclusion of sufficient numbers of patients, the use of a longitudinal study design when the objective is to study the changes of Lp(a) during pregnancy and selection of a study population that is ethnically representative for the general population.

Female↗
PubMed2005

Emergency peripartum hysterectomy: A prospective study in The Netherlands.

OBJECTIVE: To determine the incidence, indication, association with caesarean section (CS) and outcome of emergency peripartum hysterectomy (EPH) in The Netherlands. STUDY DESIGN: All 100 Dutch obstetric departments were asked to participate in a prospective nationwide registration of EPH between 1 April 2002 and 1 April 2003. For every case, a form with questions about obstetrical history, current pregnancy and delivery, maternal and neonatal outcome was completed. RESULTS: Eighty-nine (89%) hospitals participated and registered in total 48 EPH. The estimated incidence of EPH is 0.33/1000 births. The main indication for EPH was placenta accreta (50%), followed by uterine atony (27%). There were two maternal deaths (4%). Severe maternal morbidity included: urinary tract injury 15%, relaparotomy 25%, transfusion >10 units red blood cells 67%, intensive care admission 77%. Both previous CS and CS in the index pregnancy were associated with a significant increased risk of EPH. The number of previous CS was related to an increased risk of placenta accreta, from 0.19% for one previous CS to 9.1% for four or more previous CS. CONCLUSION: Emergency peripartum hysterectomy is associated with a high incidence of maternal morbidity and a case fatality rate of 4%. It is significantly related to CS in index or previous pregnancy. Placenta accreta is the most common indication to perform a peripartum hysterectomy.

Adult↗
PubMed2005

Transient loss of the diurnal rhythms of fetal movements, heart rate, and its variation after maternal betamethasone administration.

Antenatal betamethasone administration to enhance fetal lung maturation is associated with transient reductions in fetal heart rate (FHR) variation, breathing, and body movements 2 d after the first dose (d 2). This study examines whether steroid administration affects the natural diurnal rhythms of fetal variables. Sixteen women at 27-32 wk of gestation received two doses of betamethasone 24 h apart. One-hour recordings of FHR, breathing, and body movements were made in the morning, afternoon, and evening of d 2, and again in the morning of d 3. Repeat recordings were obtained at 4-6 d later from 9/16 women. Maternal blood samples were obtained with each recording to determine ACTH and cortisol. No diurnal rhythm was present for FHR, FHR variation, breathing, and body movements on d 2. This resulted from suppression of the expected natural rise in body and breathing movements, and heart rate variation in the course of the day. Suppression of the diurnal rhythm of body movements depended on gestation (R = -0.89; p < 0.01). All variables showed diurnal rhythms 4-6 d later. Maternal ACTH and cortisol diurnal rhythms were completely suppressed on d 2. Four to six days later, the normal diurnal pattern was resumed, although absolute levels of ACTH and cortisol were still suppressed. We conclude that maternal betamethasone administration transiently abolishes the fetal diurnal rhythms of heart rate and its variation, breathing, and body movements.

Adrenocorticotropic Hormone↗
PubMed2005

Severe umbilical cord acidemia and neurological outcome in preterm and full-term neonates.

BACKGROUND: Severe intrauterine hypoxia-ischemia and acidemia may lead to a disturbed neurodevelopment. OBJECTIVES: To study the effects of acidemia at birth on neurodevelopment in preterm and full-term neonates. SUBJECTS AND METHODS: Short- and long-term outcome were studied retrospectively in 44 inborn preterms and 95 full-terms with severe acidemia at birth defined as a pH of the umbilical artery <7.00. Outcome was compared with 67 preterm and 90 full-term non-acidemic neonates (pH>7.15). Intraventricular hemorrhage (preterms) or seizures (both preterms and full-terms) were considered an adverse short-term outcome. Neonatal death, cerebral palsy or neurodevelopmental delay were considered an adverse long-term outcome. RESULTS: Severe intraventricular hemorrhage (IVH) occurred in 5 of the 44 (11%) acidemic preterms and in none of the 67 (0%) non-acidemic preterms (p<0.01). Seizures were observed in 9 of the 44 (20%) and 11 of the 95 (12%) acidemic preterms and full-terms, respectively, and in none of the 67 (0%) and 1 of the 90 (1%) non-acidemic preterms and full-terms, respectively (p<0.001 for preterms, p<0.01 for full-terms). Nine preterms (6 acidemic, 3 non-acidemic) and 2 full-terms (both acidemic) died in the neonatal period. Adverse long-term outcome occurred in 32% of the acidemic preterms, in 21% of the non-acidemic preterms, in 7% of the acidemic full-terms and in 7% of the non-acidemic full-terms. CONCLUSIONS: Acidemia at birth increased the occurrence of severe IVH in preterm neonates and seizures in both preterm and full-term neonates. However, no significant effect of acidemia on long-term outcome could be demonstrated.

Acidosis↗
PubMed2005

Psychological consequences of termination of pregnancy for fetal anomaly: similarities and differences between partners.

OBJECTIVE: We examined the psychological responses to termination of pregnancy (TOP) for fetal anomaly from both men and women. The aim was to find risk factors for poor psychological outcome both for the individuals and for the couple. METHODS: A cross-sectional study was performed in 151 couples 2-7 years after TOP. We used standardized and validated questionnaires to investigate grief, symptoms of posttraumatic stress, somatic complaints, anxiety, and depression. RESULTS: Most couples adapted well to their loss, although several patients had pathological scores on posttraumatic stress symptoms and depression. Differences between men and women were slight. Higher education, good partner support, earlier gestational age, and life-incompatibility of the disorder positively influenced the outcomes, more for women than for men. Men and women with pathological scores rarely had such scores simultaneously. CONCLUSION: We emphasize the importance of equally involving both parents in the counselling because the outcomes of grief and posttraumatic stress symptoms between men and women only moderately differ and post-TOP psychopathology occurs in men as well. Good adjustment to TOP in women seems dependent on the level of support that they perceive from their partners. The intracouple results of the study suggest a mutual influence in the process of grieving between the partners.

Abortion, Induced↗
PubMed2005

Mild pyelectasis diagnosed by prenatal ultrasound is not a predictor of urinary tract morbidity in childhood.

OBJECTIVES: To determine whether children with prenatally diagnosed mild pyelectasis have more urinary tract morbidity during childhood than children without this finding. METHODS: Case-control study in children with pyelectasis (anteroposterior diameter of the fetal renal pelvis of 5-10 mm). A validated questionnaire was sent to the parents of 208 cases and 416 matched controls. RESULTS: The questionnaire was returned by 146 cases and 250 controls. There was a male predominance in the case group (p = < 0.0001). There was no difference in voiding habits or in prevalence of urinary tract infections (UTI). The prevalence of UTI was high: 11.6% in cases and 10.0% in controls. The only difference was a higher prevalence of constipation in the case group (p = 0.003). Postnatally, 41 children had an ultrasound examination and 16 were referred to a paediatrician or urologist: 3 had persisting pyelectasis, 3 had a recurrent UTI and 1 required surgery (a pyeloplasty). Four of the controls were referred to a paediatrician or urologist: 3 had recurrent UTI and 1 had urinary incontinence. CONCLUSION: Children with a mild fetal pyelectasis do not have more urinary tract morbidity during childhood than children without this finding. Therefore, there seems to be no need for additional investigation after birth.

Adult↗