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Biomedical subjects

J van Roosmalen

Publications and source records attributed to J van Roosmalen.

At least 37 records · Page 2Linked to original sources
PubMed2001

Malaria prophylaxis and the reduction of anemia at childbirth.

OBJECTIVES: To assess the effect of introducing chloroquine prophylaxis during pregnancy on prevalence of anemia (<10.9 g/dl) at childbirth and perinatal outcome. METHODS: Observational study in a rural district hospital in Ghana, which compared 2803 women who received chloroquine prophylaxis during pregnancy with 3084 historical controls, who had not received prophylaxis during pregnancy. Main outcome measures were hemoglobin level at childbirth, perinatal mortality and birth weight. RESULTS: Mean hemoglobin level before childbirth increased from 10.7 g/dl (S.D.=1.0 g/dl) to 11.0 g/dl (S.D.=0.9 g/dl). Prevalence of anemia decreased from 29.4 to 13.3% (OR=0.4 and 95% CI=0.3-0.4). Prevalence of moderately severe anemia (<9.0 g/dl) decreased from 4.4 to 3.3% (OR=0.7, 95% CI=0.6-0.97). Perinatal mortality and low birth weight (<2500 g) remained unchanged. CONCLUSIONS: Routine chloroquine prophylaxis in pregnancy is useful in reducing anemia at childbirth in malaria-endemic regions. Fetal outcome did not improve with chloroquine prophylaxis in this study.

Anemia↗
PubMed1999

Pelvic abscess in the second half of pregnancy after oocyte retrieval for in-vitro fertilization: case report.

We describe a very late manifestation of pelvic abscesses after oocyte retrieval for in-vitro fertilization (IVF). In a twin pregnancy achieved after intracytoplasmic sperm injection, rupture of bilateral ovarian abscesses occurred at the end of the second trimester. An emergency laparotomy was necessary because of an acute abdomen. This complication led to severe maternal and neonatal morbidity, preterm birth and neonatal death. The rare occurrence of acute abdomen in pregnancy due to pelvic infection and the non-specific symptoms of a pelvic abscess after oocyte retrieval for IVF are discussed.

Abdomen, Acute↗
PubMed1999

Nationwide maternal mortality in Surinam.

OBJECTIVE: To assess the magnitude, causes and associated factors of maternal mortality in Surinam. METHODS: Nationwide confidential enquiry. Maternal deaths were identified using various methods and sources for the period 1991-1993. All cases were examined by a maternal mortality expert committee for substandard care analysis. RESULTS: The national maternal mortality ratio was 226 per 100,000 live births, which is six times higher than the official maternal mortality ratio of 38 for the preceding three year period. The main causes of death were haemorrhage (30%) and pre-eclampsia (20%). In 95% of analysed cases, substandard care factors which had contributed to the deaths were present at one or more levels of maternity care. CONCLUSIONS: Maternal mortality was found to be several times higher than had been officially reported for Surinam during the previous three decades. Improvement of maternity care services in Surinam is needed, and has to be addressed at all levels, from the community, health centre and hospital to the highest level of organisation.

Adolescent↗
PubMed1998

[Paroxysmal nocturnal hemoglobinuria in pregnancy].

The combination of paroxysmal nocturnal haemoglobinuria (PNH) and pregnancy occurred in three women aged 29, 31 and 35 years. One patient had a spontaneous abortion twice after which she committed suicide. In the other two the pregnancy and parturition--assisted--were without complications. However, one woman developed post-partum abdominal crises. The children were born at term and healthy. PNH is a rare form of haemolytic anemia. Pregnancy causes lethal complications in 6% of the cases of PNH, while 30% of the pregnancies end in spontaneous abortion or stillbirth. Accurate monitoring of pregnancy and the puerperium is essential.

Abortion, Spontaneous↗
PubMed1998

[Lactation-induced amenorrhea as birth control method].

Improving access to quality care in family planning, a recent document of the World Health Organization, reviews the epidemiological and clinical evidence relevant to medical eligibility of well established contraceptive methods. Breastfeeding is widely regarded as unreliable for individual contraception. The document, however, argues that the lactational amenorrhoea method (LAM) is a safe and effective family planning method. Worldwide, LAM is the most important way of fertility regulation and its efficacy is confirmed in many studies, with a 2% risk of pregnancy in the first six months after birth. Taking into account certain well defined conditions (frequent feedings, no supplementary feeding before 4-6 months, method only to be used in the absence of menstruation), LAM can be relied on for contraceptive protection for up to 1 year post partum.

Amenorrhea↗
PubMed1998

Increased maternal mortality in The Netherlands from group A streptococcal infections.

OBJECTIVE: To assess genital tract sepsis-related maternal mortality in The Netherlands during 1983-1992. STUDY DESIGN: A nationwide Confidential Enquiry into the causes of maternal death. RESULTS: Genital tract sepsis-related maternal mortality during 1983-1987 was 0.11 per 100,000 live births (1/893,998) and 0.93 per 100,000 live births (9/968,990) during 1988-1992. The relative risk of dying due to sepsis in the second 5-year period as compared to the first period was 10.1 (1/72 versus 9/72 maternal deaths; 95% CI 1.3-82.3; P < 0.01). CONCLUSIONS: Also in The Netherlands an increase of death due to genital tract sepsis has been observed since the 1980s.

Female↗
PubMed1998

Reproductive age mortality survey to study under-reporting of maternal mortality in Surinam.

OBJECTIVES: A nationwide confidential enquiry into maternal deaths was carried out in Surinam during the years 1991-1993. Preliminary analysis showed a maternal mortality ratio (MMR) of 240 per 100000 live births, which was almost four times higher than the official MMR for the preceding decade. The question arose whether maternal deaths had been under-reported for the years 1981-1990. For these 10 years official statistics revealed 65 maternal deaths. METHODS: For the period 1981-1990 a retrospective reproductive age mortality survey was carried out in five urban hospitals covering 78% of all deliveries in Surinam. RESULTS: In these hospitals 1216 women of age 10-49 years died. Due to disorganized filing 439 medical records (36%) could not be traced. By reviewing 64% of the records, 85 maternal deaths were identified (70 direct and 15 indirect). CONCLUSION: Although only 64% of medical records could be reviewed, the number of maternal deaths identified in five hospitals (85) was 1.3 times higher than the officially reported number for the whole country (65). Maternal mortality was found therefore to be under-reported in Surinam for the period 1981-1990.

Adolescent↗
PubMed1998

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). RESULTS: All dosage groups consisted of three women, except those with 100 microg (n=6) and 200 microg (n=18). Recorded were dose-limiting adverse events: hyper- or hypotension (three), severe abdominal pain (0), vomiting (0) and retained placenta (four). Serious adverse events occurred in seven women: six cases with blood loss > or = 1000 ml, four cases of manual placenta removal, five cases of additional oxytocics administration and five cases of blood transfusion. Maximum blood loss was greatest at the upper and lower dose levels, and lowest in the 70-125 microg dose range. Four out of six cases with blood loss > or = 1000 ml occurred in the 200 microg group. The majority of additional administration of oxytocics (4/5) and blood transfusion (3/5) occurred in the dose groups of 200 microg. All retained placentae were found in the group of 200 microg. CONCLUSION: The MTD was calculated to be at 200 microg carbetocin.

Abdominal Pain↗
PubMed1998

Confidential enquiry into maternal deaths in The Netherlands 1983-1992.

OBJECTIVE: To determine the causes of maternal death in The Netherlands. STUDY DESIGN: Nationwide Confidential Enquiry into the Causes of Maternal Deaths during the period 1983-1992. RESULTS: Of 192 direct and indirect maternal deaths, 154 (80%) were available for the Enquiry. The most frequent direct causes were (pre-)eclampsia, thrombo-embolism, obstetrical haemorrhage and sepsis. Cerebro- and cardiovascular disorders were the most frequent indirect causes of death. Age above 35 years and parity 3 or more are related to higher maternal mortality. Women from non-caucasian origin are more prone to death in comparison to caucasian women. Autopsy was performed in 88 cases (57%). Of the 24 women where labour started at home, the place of birth played a significant role in delay in four. CONCLUSIONS: More efforts should be made to have a higher percentage than 80% available for the Confidential Enquiry as in the UK where only 1-4% of deaths are not available for similar purposes. Also, the autopsy rate of 57% is much lower than in the UK (82%). Special strategies should be developed to improve maternal health of populations at higher risk such as women of high age and parity and immigrant populations.

Adolescent↗
PubMed1998

Cervicovaginal fetal fibronectin concentrations: predictive value of impending birth in postterm pregnancies.

OBJECTIVE: To determine the predictive value of cervicovaginal fetal fibronectin (fFN) concentrations > or =50 ng/ml for spontaneous onset of labour within 3 days in pregnancies of 41 weeks gestation or more. STUDY DESIGN: In the Department of Obstetrics, Leiden University Medical Centre, and of the Diaconessen Hospital, Voorburg (The Netherlands), 126 cervicovaginal secretions of fFN, from 80 consenting women between 287 and 304 days gestation were collected. Pregnant women underwent sterile speculum examinations for cervicovaginal sampling from the 41st week onwards. The fFN concentration in these samples was determined with a quantitative solid-phase enzyme-linked immunosorbent assay. Concentrations of <50 ng fFN per ml were characterised as negative test results, meaning that spontaneous delivery would not take place within 3 days, and those of > or =50 fFN ng/ml were taken as positive test results. Sensitivity and specificity of the fFN test were calculated for predicting spontaneous birth. Parametric and nonparametric tests were used for evaluating differences and correlations. RESULTS: Spontaneous delivery took place after 2.5+/-2.5(SD) days with fFN values > or =50 ng/ml and after 4.7+/-3.6 days with fFN concentrations <50 ng/ml (P<0.001). Sensitivity and specificity of the fFN test predicting spontaneous onset of labour within 3 days, were 0.71 [95% confidence interval (CI) 0.58-0.86] and 0.64 (95% CI 0.48-0.78). If fFN > or =50 ng/ml then a spontaneous onset of labour is more likely to occur within 3 days (odds ratio 4.5 (95% CI 1.8-11.3). CONCLUSIONS: The fFN test does not predict accurately enough whether or not birth will take place within 3 days of sampling. Nevertheless, the higher odds for spontaneous delivery within a few days when the test is positive may be of use in planning adjusted induction of labour.

Cervix Uteri↗
PubMed1998

Ergot alkaloids. Current status and review of clinical pharmacology and therapeutic use compared with other oxytocics in obstetrics and gynaecology.

Ergot alkaloids are well known preparations. Ergot alkaloids used in obstetrics and gynaecology are ergometrine (ergonovine; EM), methylergometrine (methergine; ME) and bromocriptine. The pharmaceutical properties of ME EM) are critical. To guarantee stability, ME and EM ampoules should be stored in a cool, dark place. ME and EM tablets are unstable in all conditions and they show an unpredictable bioavailability, which prevents oral use of the drugs for any purpose. ME and EM are known for their strong uterotonic effect and, compared with other ergot alkaloids, for their relatively slight vasoconstrictive abilities. ME and EM do have a place in the management of the third stage of labour as they are strong uterotonics. They act differently from oxytocin and prostaglandins, and have different adverse effects. Oxytocin should be used as prophylaxis or a the drug of first choice; next, ME or EM should be used, and if none of these drugs produce the desired effects, prostaglandins should be used to control bleeding. Ergot alkaloid use in gynaecology has been limited and today is discouraged even in essential menorrhagia. It is suggested that EM and ME be used (parenterally) only in first trimester abortion curettage, to reduce blood loss. Bromocriptine has been used for lactation suppression. However, alternatives such as cabergoline, which possess fewer adverse effects, are now available and therefore preferred for this indication. In sum, there is no place for the prophylactic use of ME and EM in obstetrics or gynaecology. They can be used for therapeutic purposes in the third stage of labour. During use, the practitioner must be alert for adverse effects.

Ergonovine↗
PubMed1997

[Continuation of pregnancy in infaust fetal prognosis].

In three pregnant women, lethal anomalies of the fetus were diagnosed ultrasonographically in the second trimester. These women decided to continue their pregnancies for different reasons. One woman strongly regretted her decision to abort a previous pregnancy. The second hoped that the doctors were mistaken on the prognosis. The third woman was afraid of medical interventions. In case of lethal anomalies of the fetus, doctors should advise their patients to consider both options: termination as well as continuation of their pregnancy. Irrespective of the women's choice, doctors ought to be committed to support the pregnant women in such a troublesome situation.

Abortion, Therapeutic↗
PubMed1997

[Diagnostic and therapeutic dilemmas in malignancy during pregnancy].

In four pregnant women, aged 28, 29, 30, and 35, malignancies were diagnosed: synoviosarcoma, gastric carcinoma, non-Hodgkin B cell lymphoma and undifferentiated adenocarcinoma in one of the labia vulvae, respectively. The first three women eventually died, the first before giving birth, the last woman was treated surgically and was alive without recurrence two years after treatment. Pregnancy can lead to diagnostic dilemma and delay as many symptoms of a malignancy are not recognised as such but are attributed to the pregnant state and because of reluctance to apply diagnostic tools which can be harmful to the foetus. It can also lead to therapeutic dilemma and delay because several therapies may also harm the foetus.

Adult↗