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Biomedical subjects

J van Roosmalen

Publications and source records attributed to J van Roosmalen.

At least 55 records · Page 3Linked to original sources
PubMed1997

[Beyond maternal death?].

Three women, aged 33, 27, and 31 years, had serious gestational problems (pre-eclampsia with cerebral haemorrhage, toxic shock syndrome with multiple organ failure, and hypertension complicated by prolonged circulatory arrest, respectively), but eventually survived, albeit with serious handicap (cognitive and motor disturbances, blindness, and persistent vegetative state, respectively). When the maternal mortality ratio is as low as it currently is in the Netherlands (10 women in 100,000 live births), it is worthwhile to assess cases of severe maternal morbidity. The cases presented lead to the pertinent question whether obstetric interventions to prevent death may not sometimes be worse than accepting death itself.

Adult↗
PubMed1997

Complications of cervical cerclage in rural areas.

OBJECTIVE: To determine whether the outcome of pregnancies following cervical cerclage in rural Tanzania justifies its application in remote areas. METHOD: Retrospective review of 16 singleton pregnancies in 13 women, who underwent cervical cerclage in a rural hospital in Tanzania during 1990-1995. RESULTS: Ten (62.5%) live children were born. Seven women (43.8%) delivered after a gestational age of 37 weeks. Severe maternal complications were encountered 5 times (31.3%): 4 severe cervical lacerations and 1 uterine rupture. CONCLUSION: One should be reluctant to apply cervical cerclage in remote rural areas due to the high rate of maternal complications, as patients' delay in reaching the hospital may be considerable in cases of preterm birth.

Adult↗
PubMed1997

Trial of labour after previous caesarean section in rural Zimbabwe.

OBJECTIVE: Vaginal delivery after previous caesarean section is widely accepted in Western countries. Is a trial of labour in rural Africa also safe for mother and child? STUDY DESIGN: In a case control study in rural Zimbabwe the outcome of labour of 281 women who had one or more previous caesarean sections was compared with 4501 women who had no previous caesarean section. Maternal and perinatal mortality, the percentage of vaginal birth and factors related to the achievement of vaginal delivery were studied. Data were tested for statistical significance with a Mantel-Haenszel equation for odds ratio's. RESULTS: No elective caesarean sections were performed. After previous caesarean section, 124 (44%) out of 281 women had a vaginal birth. One scar rupture occurred in a woman with thyrotoxicosis. Perinatal and maternal outcome did not differ significantly between cases and controls. A history of more than one previous caesarean section (Odds Ration (OR) = 10.0; 95% Confidence Interval (CI95%) = 4.4-23.8) or a previous caesarean section for cephalopelvic disproportion (OR = 6.2; CI95% 3.2-120) increased the risk for a repeat caesarean section significantly. CONCLUSION: A policy to allow all women a trial of labour after a previous caesarean section did not increase adverse pregnancy outcome. Also in rural Africa it seems rational to encourage a trial of labour after one or more previous caesarean sections.

Cesarean Section↗
PubMed1997

The aetiology of low birthweight in a rural area of Tanzania.

In a hospital-based study, birthweights of 3162 consecutive births were related to perinatal mortality, multiple birth, and gestational age. Independent associations between 15 potential determinants and low birthweight, prematurity and small-at-term factors were also assessed. A newly constructed local curve of birthweight-for-gestational age is compared with the existing curves. The variables positively associated with low birthweight (< 2500 g) were nulliparity, vomiting as a self-reported complaint, spleen enlargement, sex of the infant and previous perinatal mortality. Nulliparity and spleen enlargement were positively associated with preterm birth, while small-at-birth was mostly associated with nulliparity and sex of the infant. Further study on spleen enlargement, the only modifiable factor in this study of possible public health importance, is warranted. Other factors of potential importance which deserve further investigations are hard physical work, maternal morbidity and antenatal care.

Female↗
PubMed1997

Worldwide prevention of vertical human immunodeficiency virus (HIV) transmission.

Most human immunodeficiency virus (HIV) infected children acquire the infection by perinatal transmission. Strategies for the prevention of perinatal HIV transmission mainly focus on conditions that prevail in industrialized countries, although most of these children are born in areas with less privileged circumstances. This review takes these circumstances into consideration when addressing six potential strategies to reduce perinatal HIV transmission.

Breast Feeding↗
PubMed1997

Maternal mortality after cesarean section in The Netherlands.

BACKGROUND: To assess cesarean section-related maternal mortality in The Netherlands during 1983-1992. METHODS: A nationwide confidential enquiry into the causes of maternal death. RESULTS: The risk of dying after vaginal birth was 0.04 per 1000 vaginal births (65/1.763.999) compared to 0.53 per 1000 cesarean births (57/108.587). The direct risk of dying from cesarean section was 0.13 per 1000 operations (14/108.587). In some women cesarean section did not initiate, but contributed to, the train of events leading to death. Adding this associated risk to the direct risk gives a fatality rate of 0.28 per 1000 cesarean births (30/108.587). CONCLUSIONS: Although cesarean section is a relatively safe procedure nowadays, birth by cesarean section in The Netherlands is seven times more hazardous than vaginal birth. Keeping the cesarean birth rate as low as possible is therefore in the interest of women of reproductive age.

Adult↗
PubMed1997

Tick-borne relapsing fever and pregnancy outcome in rural Tanzania.

OBJECTIVE: To assess the impact of tick-borne relapsing fever (TBRF) on the outcome of pregnancy. DESIGN: Case control study of 137 pregnant women (cases) and 120 non-pregnant women (controls) with TBRF between 1985 and 1995. SETTING: A rural hospital in Tabora Region, Tanzania. RESULTS: Risk of birth during the attack of TBRF was 58.0%, with an extremely high perinatal mortality of 436 per 1000 births. The total loss of pregnancies including abortions was 475. per 1000. Case-fatality rate in pregnant women was 1.5%, compared to 1.7% in the non-pregnant women. A Jarisch-Herxheimer reaction was seen in 1.5% of the cases and in 1.7% of controls. Relapse rate was 3.6%, compared to 1.7% in non-pregnant women. Pregnant women with TBRF show higher densities of spirochetes than non-pregnant women (p < 0.001). The risk of delivery during the attack was positively correlated to increasing density of the spirochetemia (p < 0.001) and to gestational age (p < 0.001). Perinatal death was related to low birthweight (p < 0.001) and low gestational age (p < 0.001) and not to degree of spirochetemia. CONCLUSIONS: The extremely high perinatal mortality rate during an attack asks for prevention and early effective management of TBRF. This is a challenge where access to health services in rural areas of developing countries is hampered by many factors.

Adult↗
PubMed1997

Maternal mortality in rural Zambia.

OBJECTIVE: To assess maternal mortality. DESIGN: Sisterhood method survey and hospital data. SETTING: Communities in Kalabo District, a very remote rural area in western Zambia; Kalabo District Hospital. RESULTS: The number of respondents in the sisterhood method survey was 1,978. The estimated maternal mortality ratio derived from this survey was 1,238 per 100,000 live births. The hospital study involved 2,474 deliveries of 2,374 live babies. The official number of maternal deaths was 13. Further investigation of files revealed an additional 15 maternal deaths, bringing the institutional maternal mortality rate from 548 to 1,179 per 100,000 live births. The major causes of direct maternal deaths were obstructed labor and sepsis. In 71% of all cases substandard care factors contributed. CONCLUSIONS: Maternal mortality in rural Zambia is among the highest as reported in the world. Official hospital data tend to underestimate maternal mortality in the community due to underreporting. The sisterhood method survey is an efficient indirect method to assess maternal mortality in rural areas of developing countries.

Adolescent↗
PubMed1996

Survey of the management of third stage of labour in The Netherlands.

UNLABELLED: The standard practice during the third stage of labour of Dutch midwives and obstetricians was elucidated by a questionnaire mailed to all Dutch midwives and obstetricians. Prophylactic oxytocics in the third stage are used as a routine by 55% of the obstetricians and only 10% of the midwives. Oxytocin is the drug of first choice. CONCLUSION: Routine use of prophylactic oxytocics in the third stage is not the standard practice in the Netherlands. Obstetricians are much more likely to use prophylaxis than midwives.

Female↗
PubMed1996

A placebo-controlled trial of oral ergometrine to reduce postpartum hemorrhage.

BACKGROUND: Active management with oral ergometrine 0.4 mg was compared with expectant management for the control of blood loss in the third stage of labor in women at low risk of postpartum hemorrhage (PPH). METHODS: A three-arms randomized trial in which 0.4 mg ergometrine (2 tablets of 0.2 mg) was set off against placebo, both groups allowing comparison with a standard oxytocin regimen of 5 IU. Women at low risk for PPH. Of 367 parturients, 146 were randomised to ergometrine 0.4 mg, 143 to placebo and 78 to intramuscular oxytocin in a 2:2:1 design. RESULTS: Compared with placebo, ergometrine reduced blood loss with 5% (-5%; Confidence interval: -20% to +13%). Oxytocin reduced blood loss with 9% (-9%; Confidence interval: -26% to +12%) versus placebo. CONCLUSION: Oral ergometrine has too little effect on blood loss after childbirth in order to be a good alternative to parenteral prophylactic management.

Administration, Oral↗
PubMed1995

The development of a local symphysis-fundal height chart in a rural area of Tanzania.

In this prospective community-based study, a symphysis-fundal height chart was constructed, derived from 403 measurements in 83 women, in a local rural population. Using the recommended Cardiff chart, 132 measurements (32.9%) were below the 10th centile line, while only two measurements were above the 90th centile line. This may indicate that a high percentage of the Tanzanian fetus are growth retarded or genetically small. The relative importance of each of these remains unknown. Use of the Cardiff chart in rural Tanzania could result in unnecessary referrals, which is undesirable in view of both the women involved and strained resources. Therefore, the use of a symphysis fundal height chart, based on measurements in the local population, is recommended.

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↗
PubMed1995

Single pre-delivery symphysis-fundal height measurement as a predictor of birthweight and multiple pregnancy.

OBJECTIVE: To compare the value of different pre-delivery maternal indices for predicting birthweight, and to examine the usefulness of a single pre-delivery symphysis-fundal height measurement for the detection of low birthweight and twin pregnancy or macrosomia. DESIGN: Symphysis-fundal height measurements were gathered from 1509 women who had both a singleton delivery and available data of pre-delivery weight, height and mid-upper arm circumference, and from 73 women who had a twin delivery. SETTING: A district hospital in rural Tanzania. RESULTS: Symphysis-fundal height, pre-delivery weight and mid-upper arm circumference, respectively, explain 41%, 13% and 4% of the observed variation in birthweight. At a cut-off level of 30 cm for symphysis-fundal height, the detection rate for birthweight below 2500 g and 2000 g was 66% and 68%, respectively, and the false positive rate was 9% and 14%, respectively. At a cut-off level of 38 cm for symphysis-fundal height the detection rate for twin pregnancy or birthweight > or = 4000 g was 76%, and the false positive rate was 4%. CONCLUSION: Symphysis-fundal height was a better predictor of birthweight than maternal height, pre-delivery weight or mid-upper arm circumference. It seems justified to investigate the value of a simple tricoloured symphysis-fundal height measuring tape for use in antenatal care in developing countries at village level.

Adolescent↗
PubMed1995

Comparison of the bioavailability and pharmacokinetics of oral methylergometrine in men and women.

OBJECTIVE: To assess and compare the pharmacokinetics and bioavailability of methylergometrine (ME) in men and non-pregnant women. DESIGN: A cross-over design was used for an oral dose of 0.125 mg and an intravenous dose of 0.200 mg of ME in 6 men and 6 non-pregnant women (parallel-design in gender). RESULTS: After intravenous administration, the pharmacokinetic profile of ME was described with a 2-compartment model. The distribution half-life (t1/2 alpha) in men was 0.19 +/- 0.27 h, in women 0.10 +/- 0.04 h, the elimination half-life (t1/2 beta) 1.85 +/- 0.28 h, respectively, 1.94 +/- 0.34 h and the total body clearance (CL) 33.2 +/- 11.8 l.h-1, and, respectively, 22.18 +/- 3.10 l.h-1. For these intrinsic pharmacokinetic parameters differences between men and women were not statistically significant. After oral administration, the pharmacokinetic profile was described with a 1-compartment model. The lag time was subject dependent and was significantly longer in men 0.33 +/- 0.09 h than in women 0.09 +/- 0.07 h. T1/2 beta in men was 2.08 +/- 0.43 h and was longer than in women 1.42 +/- 0.31 h (p = 0.012). In both men and women a large variation of bioavailability was shown ranging between 22% and 138%. CONCLUSION: This study with oral methylergometrine showed a comparable large interindividual variability in bioavailability in both men and women.

Administration, Oral↗
PubMed1995

Caesarean birth rates worldwide. A search for determinants.

High caesarean birth rates are an issue of international public health concern. Determinants of caesarean birth are reviewed in order to formulate strategies to reduce these high rates. A strong independent profession of highly qualified midwives, who care for women with low-risk pregnancies, may contribute to a relatively low caesarean birth rate. Different clinical policies which influence the intervention rate, are discussed for the most frequent reasons to perform caesarean section: dystocia, repeat caesarean birth, breech delivery and foetal distress. The risks and safety of caesarean birth differ from place to place in this world. As the relative safety of the procedure is an important factor contributing to the rise of caesarean birth, the fact that this has only been achieved in some parts of the world should restrict the indications to perform the operation in the best interests of pregnant women.

Birth Rate↗