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H I Wildschut

Publications and source records attributed to H I Wildschut.

At least 19 recordsLinked to original sources
PubMed1999

[Parvovirus B19 infection in pregnancy: a cause of non-immune hydrops fetalis].

Four pregnancies, in two women aged 39 and two women aged 34 years respectively, were complicated by foetal parvovirus B19 infection. First-trimester intrauterine death resulting from multiple congenital anomalies was diagnosed in one patient with proven foetal parvovirus B19 infection. In three patients foetal hydrops was found in the second trimester with variable clinical course. In one of them, foetal hydrops resulted in second-trimester foetal death; in another, foetal hydrops resolved following intrauterine blood transfusion and in a third foetal hydrops resolved spontaneously. Foetal parvovirus B19 infection was diagnosed by polymerase chain reaction (PCR) using foetal cells obtained by amnioscentesis. It is concluded that maternal parvovirus B19 infection is mostly asymptomatic. However, the clinical impact of maternal infection on the foetus is diverse, i.e. infection may result in foetal death or--transient--foetal morbidity, in particular foetal anaemia. In mothers with proven foetal parvovirus B19 infection close monitoring of the foetus by ultrasound is warranted. Occasionally intrauterine transfusion is required. From the literature to date, the estimated incidence of maternal parvovirus B19 infection in pregnancy is 3-7%. The vertical transmission rate approximates 30%. When pregnancy is complicated by foetal hydrops foetal parvovirus B19 infection should be kept in mind.

Adult↗
PubMed1999

Practice variation of test procedures reportedly used in routine antenatal care in The Netherlands.

BACKGROUND: Pregnant women are encouraged to book for antenatal care. However, little is known about the contents of antenatal care, in particular regarding various test procedures. The present descriptive study was conducted to assess the variation in standard test procedures in antenatal care in The Netherlands. METHODS: A nationwide structured survey by mailed questionnaire was carried out among specialist obstetricians and midwives in The Netherlands. Representatives of each obstetric practice registered with the Dutch Society of Obstetrics and Gynecology (n=132) and a sample of midwives registered with the Dutch Society of Midwives (n=394) were invited to report the standard policy of tests routinely used for antenatal care in their own setting. Furthermore, they were asked to report their views on the potential impact of the antenatal care program on pregnancy outcome. RESULTS: Complete information was available from 105 specialist obstetricians (80%) and 281 midwives (71%). The assessment of maternal blood pressure and weight are reportedly the commonest procedures routinely conducted during the antenatal period. However, within each profession reported definitions and implications of abnormal findings vary markedly, especially in the fields of identification and management of hypertensive disorders in pregnancy. Serial examination of the cervix is not standard policy among both groups. With respect to laboratory tests, considerable intra- and interprofessional variations are reported, in particular those for maternal serum glucose, rubella antibody titer and urinary dipstick for glucose and protein. As to standard ultrasound policies, wide intra- and interprofessional variations are noted. Seventy-two specialist obstetricians (68%) and 92 midwives (33%) routinely estimate the duration of gestation by ultrasound in pregnant women (p<0.001). A fetal anomaly scan at about 18-20 weeks' gestation is routinely offered to pregnant women by 31 specialist obstetricians (30%) and 44 midwives (16%) (p<0.01); 29 obstetricians (28%) and 11 midwives (4%) reportedly use ultrasound in all pregnant women for the detection of fetal growth restriction (p<0.001). Overall, midwives have a more optimistic view about the impact of antenatal care on pregnancy outcome than obstetricians. CONCLUSIONS: Although the standard package of antenatal care provided by both specialist obstetricians and midwives in The Netherlands seems to be relatively uniform, wide intra- and interprofessional variations exist with respect to (1) the application of tests in terms of recommendations to test some or all pregnant women, (2) defining normal from abnormal and (3) potential implications of abnormal findings.

Blood Pressure Monitoring, Ambulatory↗
PubMed1998

Abnormal karyotypes in semi-direct chorionic villus preparations of women with different cytogenetic risks.

Among 3499 cytogenetically investigated semi-direct chorionic villus samples, 219 (6.3 per cent) abnormal karyotypes were encountered. The karyotypes were considered certainly abnormal (generalized abnormal with high probability) in 109 cases (3.1 per cent), and in 110 cases (3.1 per cent) uncertainly abnormal (potentially confined to the placenta), requiring further investigation. Of these 110 uncertain abnormalities, the cytogenetic result turned out to be finally abnormal representing generalized abnormality in 36 cases (32.7 per cent), finally normal representing confined placental mosaicism (CPM) in 69 cases (62.7 per cent), and remained undetermined in 5 instances (4.5 per cent). The rate of the numbers of certainly abnormal and all (certainly + uncertainly) abnormal results, the certainty rate, and that of generalized abnormalities and all abnormalities (generalized abnormalities + CPM cases), the predictive value, are strongly correlated with the cytogenetic risk. Therefore, we advise chorionic villus sampling for cytogenetic investigation only in women with a cytogenetic risk equal to or exceeding that of a 40-year-old pregnant woman. Because of the high rate of prenatal follow-up investigations after the finding of uncertain results in semi-direct villi, semi-direct and cultured villi should be karyotyped simultaneously.

Adult↗
PubMed1997

Are sociodemographic factors predictive of preterm birth? A reappraisal of the 1958 British Perinatal Mortality Survey.

OBJECTIVE: Reassessment of the predictive value of sociodemographic factors on preterm birth. DESIGN: Population-based case-control study. SETTING: England, Wales and Scotland. SAMPLE: The study sample consisted of 5630 primiparous and 9538 multiparous women who were delivered during the first week of March 1958 in Britain. Multiple births were excluded. METHOD: Factors potentially predictive of preterm birth were assessed for primiparous and multiparous women separately, using the split-sample cross-validation technique. MAIN OUTCOME MEASURE: Preterm birth, defined as birth occurring before 259 days of gestation. RESULTS: Preterm birth rates for primiparous and multiparous women were 54 and 53 per 1000 births, respectively. In primiparous women low maternal age (under 20 years) was the only sociodemographic variable that was predictive of preterm birth (P = 0.01). However, only 10.7% of preterm birth among primiparous women was associated with low maternal age. In multiparous women, using univariable analysis, employment status was statistically significantly associated with preterm birth. This association disappeared when employment status was adjusted for by other variables in the model. Social class was not predictive of preterm birth in either primiparous or multiparous women. CONCLUSION: From the results of this study it is concluded that sociodemographic factors do not have a substantial impact on the risk of preterm birth. It seems unlikely that preventative measures aimed at social-demographic adversity will reduce preterm birth rates.

Case-Control Studies↗
PubMed1997

The effect of chorionic villus sampling on the number of fetal cells isolated from maternal blood and on maternal serum alpha-fetoprotein levels.

Fetal cells are present in the circulation of pregnant women and can be isolated using density gradient centrifugation and magnetic cell sorting. In the present study, maternal cell preparations were depleted for CD45- and CD14-positive cells and enriched for CD71-positive cells. The number of fetal nucleated cells was determined using fluorescence in situ hybridization for X and Y chromosomes. Analysis of maternal blood samples taken before and after transabdominal chorionic villus sampling (TA-CVS) showed an increase in the number of fetal cells in 10 out of 19 male pregnancies after the invasive procedure. This cellular transfusion was found to correlate with elevated maternal serum alpha-fetoprotein levels. TA-CVS-induced cellular transfusion may form a good in vivo system to optimize fetal cell isolation procedures and to study fetal cell dynamics and characteristics.

Adult↗
PubMed1995

Planned abdominal compared with planned vaginal birth in triplet pregnancies.

OBJECTIVE: To compare a policy of planned abdominal delivery with a policy of planned vaginal delivery in triplet pregnancies. DESIGN: Retrospective study. SETTING: Two Dutch university hospitals, each having a different approach to the planned mode of delivery in triplet gestations. SUBJECTS: Thirty women giving birth to triplets in the hospital in Leiden, who favoured planned abdominal delivery, compared with 39 from the Medical Centre in Amsterdam who favoured vaginal delivery. MAIN OUTCOME MEASURES: Perinatal mortality and early neonatal complications. RESULTS: Both centres were equally successful in achieving their planned policies: in Leiden 80% of women were delivered by caesarean section but in Amsterdam 87% of women were delivered vaginally. Compared with vaginal delivery, planned abdominal delivery was associated with a significantly higher perinatal mortality rate (P = 0.02), primarily due to respiratory distress syndrome, and a higher recorded neonatal complication rate (P = 0.03), especially sepsis, respiratory distress syndrome, and necrotising enterocolitis. CONCLUSIONS: A policy of planned abdominal delivery in triplets is not superior to a policy of planned vaginal delivery in terms of fetal and early neonatal outcome.

Adult↗
PubMed1994

[Ambulance transportation time of obstetrical patients].

OBJECTIVE: To examine the time the ambulance needs to transfer women in labour, or immediately after delivery, from home to hospital. DESIGN: Descriptive. SETTING: Amsterdam, the Netherlands. METHOD: Ambulance data from the 'Centrale Post Ambulancevervoer', region Amsterdam, were analysed over a period of one year (1992/1993). RESULTS: Of the 287 women who were transported during labour with urgency code A1 (critical condition) 244 (85%) arrived within 0.5 h in hospital, of 124 who were not in a critical condition (urgency code A2) 66 (53%) (chi 2 = 47.2; p < 0.00001). The average duration for A1 transport of the 51 women who were transferred immediately after delivery, was 32 min. Of those who went by ambulance with urgency code A2 (n = 86) the average duration was 37 min. For A1 transport the ambulance is legally bound to arrive within 15 min. In 7 women (2%) the transport time exceeded 15 min. This was not associated with time of day or distance to hospital. Factors that influenced the duration of ambulance transport included the allocated emergency code, the timing of transport in relation to parturition and the distance between the home and hospital. CONCLUSION: In the municipality of Amsterdam transportation by ambulance of obstetrical patients from home to hospital can in most cases be realised within 0.5 h. The difference in average total time between A1 and A2 transport during labour is only 7 min, but the likelihood of arriving at the hospital within 0.5 h is much greater with A1 than with A2 transport.

Adult↗
PubMed1994

Vasectomy and the risk of prostate cancer.

Even if there is a weak association between vasectomy and subsequent prostate cancer, we believe that large-scale studies on this question should be of low priority in developing countries where vasectomy is widely practised and where the incidence of prostate cancer is low. Arguments to justify this point of view are presented.

Developing Countries↗
PubMed1993

Pre-eclampsia.

Explore the source record for details and available documents.

Female↗
PubMed1993

The potential value of a short self-completion questionnaire for the assessment of habitual physical activity in pregnancy.

The aim of this methodological study was to validate a newly designed self-completion questionnaire assessing various dimensions of physical activity among 100 pregnant women in Bristol, UK. For this purpose different measures obtained by self-completion questionnaire were compared with those simultaneously obtained by two established assessment methods for physical exertion. Based on the findings it was suggested that the self-completion questionnaire be slightly modified by adding questions pertaining to household activities and deleting questions which proved to be conceptually meaningless. It is concluded that in future studies this strategy will facilitate the understanding of the complex relationship between way of life and pregnancy outcome.

Activities of Daily Living↗
PubMed1991

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↗
PubMed1991

Determinants of preterm birth in Curaçao, Netherlands Antilles.

In order to identify risk factors for preterm birth in singletons, data from a population-based case control survey on the island of Curacao were re-analysed. Both medical and sociodemographic variables were examined. Overall, a history of previous preterm birth and severe hypertension during the index pregnancy were indicators of adverse pregnancy outcome, in terms of preterm birth. The contribution of sociodemographic factors to the risk of preterm birth is relatively low.

Abortion, Spontaneous↗