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Biomedical subjects

J van Roosmalen

Publications and source records attributed to J van Roosmalen.

At least 73 records · Page 4Linked to original sources
PubMed1994

Pharmacokinetics and bioavailability of oral ergometrine in male volunteers.

The aim of this investigation was to assess the pharmacokinetics and bioavailability of ergometrine in six human male subjects after an oral dose of 0.200 mg and after an intravenous dose of 0.075 mg of ergometrine maleate. A large variation in bioavailability of between 34% and 117% in the six volunteers was observed. The lag time was also subject dependent and ranged between 0.0073 h (0.4 min) and 0.47 h (28 min). After intravenous administration, the pharmacokinetic profile can be described by a two-compartment model. The distribution half-life t1/2 alpha is 0.18 +/- 0.20 h, the elimination half-life t1/2 beta is 2.06 +/- 0.90 h, the total body clearance (CL) amounts to 35.9 +/- 13.4 l h-1 and the steady-state volume (Vss) of distribution is 73.4 +/- 22.01. After oral administration, the pharmacokinetic profile can be described by a one-compartment model. The absorption half-life t1/2 abs is 0.19 +/- 0.22 h, and the elimination half-life t1/2 beta 1.90 +/- 0.16 h. This study with oral ergometrine shows such a large interindividual variability in bioavailability that the oral route of administration does not seem not to be the most reliable means of accurate dosing in preventing post-partum haemorrhage.

Administration, Oral↗
PubMed1994

A fetus with a parvovirus B19 infection and congenital anomalies.

A fetus with multiple structural defects was seen at prenatal ultrasound examination. After termination of the pregnancy a bilateral cleft lip, alveolus, and palate; micrognathia; and webbed joints were seen. Fetal tissues showed indications of infection, intranuclear inclusion bodies, chronic stress, haemolysis, arterial wall damage, and profuse haemorrhage. Parvovirus B19 DNA was detected in fetal tissues by dot hybridization after polymerase chain reaction. The possibility of parvovirus B19 infection leading to congenital malformations is discussed.

Adult↗
PubMed1994

Assessment of maternal mortality in Tanzania.

OBJECTIVE: To assess maternal mortality. DESIGN: Prospective community-based survey, a sisterhood method survey and hospital data. SETTING: The study was performed in communities in a rural area in Northwestern Tanzania and the local district hospital. RESULTS: Four hundred and forty-seven pregnant women in the community survey were followed up as far as six weeks after delivery; there were 2865 respondents in the sisterhood survey; the hospital study involved 7526 deliveries. Maternal morality ratios derived from the prospective community-based survey, the sisterhood method survey and hospital data analysis were 241, 297, and 845 per 100,000 live births, respectively. CONCLUSIONS: Hospital data tend to overestimate maternal mortality in these communities. The sisterhood method is easier and more convenient than a prospective community-based study.

Adolescent↗
PubMed1994

Comparison of perinatal outcome in rural Tanzania as obtained from a prospective community-based survey and hospital data.

The objective of this study was to measure perinatal mortality rate (PMR), percentage of low birth weight (LBW) and twinning rate, as obtained from a prospective community-based survey and hospital data. The community survey was performed in five villages in North-western Tanzania recruiting 447 pregnant women, while the study in the local District Hospital included 3,056 hospital deliveries. PMR was 68/1,000 in the community survey and 96/1,000 births in hospital. Stillbirths accounted for 81% of perinatal mortality in hospital as compared to 41% in the community-based survey. Percentages of LBW were 9.9 and 14.6 and twinning rates were 14/1,000 and 39/1,000 births in the community study and hospital, respectively. Perinatal mortality, low birth weight and twinning rates in hospital were higher than in the community survey. Estimations of perinatal outcome in hospital cannot be extrapolated to the community concerned.

Birth Rate↗
PubMed1994

Chest circumference as a screening method for low birth weight in newborns in rural Tanzania.

This study examines the value of head-, chest- and mid-upper arm circumference (MUAC), and crown-to-coccyx length as a screening method for low birth weight. Results are presented of 2,710 consecutive live births, excluding infants with severe congenital abnormalities. Chest circumference (r = 0.84) and MUAC (r = 0.79) correlated best with birth weight. Variance in birth weight was explained by chest circumference in 70%, while a model including all variables accounted for 79%. At a cut-off level of 30.0 cm for chest circumference, detection rate for birth weight below 2,500 g and 2,000 g was 67% and 96%, respectively, while false-positive rate was 3 and 10%. At a cut-off level of 9.0 cm for MUAC, detection rate for birth weight below 2,500 and 2,000 g was 72% and 95%, respectively, while false-positive rate was 8% and 15%. Chest circumference is recommended as the first stage screening method of choice for LBW, when no weighing scale is available.

Anthropometry↗
PubMed1993

Assessment of the risk approach to maternity care in a district hospital in rural Tanzania.

OBJECTIVE: The impact of the risk approach to maternity care in a district hospital in rural Tanzania has been investigated. METHOD: Data have been derived from a 1-month study. Of the women who lived within 5 km of a hospital (area I) 98% actually gave birth in hospital. The pattern of complications of this area is assumed to be representative for the pattern of the district as a whole. RESULT: Only 36/168 (21%) women with high risk pregnancies living further than 5 km from a hospital, came to hospital for delivery. Of the women with low risk pregnancies (in area I) 4/89 (5%) still had a complicated delivery. CONCLUSION: The risk approach, used to select women with high risk pregnancies should be used more extensively and as unexpected complications at the local center occur, basic facilities to deal with those problems should be made available at this level.

Catchment Area, Health↗
PubMed1993

Ergotamine-induced fetal stress: review of side effects of ergot alkaloids during pregnancy.

A case of sudden fetal stress after accidental administration of ergotamine tartrate (2 mg) suppository is reported. Caesarean section was performed because of unexplained fetal stress. In retrospect, we conclude that it is likely that sudden fetal stress was caused by the severe vasoconstrictive effect of ergotamine. The side effects of ergot derivatives during pregnancy are discussed.

Adult↗
PubMed1992

Conservative management of placental abruption complicated by severe clotting disorders.

Placental abruption resulting in fetal death may seriously affect maternal health, especially when clotting disorders arise. The prevailing view is that the clotting system will only normalize after the uterus has been evacuated and therefore prompt delivery, often by induction of labor, is advocated. Over a 3-year period, 16 cases (0.35%) of intra-uterine fetal death due to placental abruption occurred at Leiden University Hospital. Five cases were complicated by severe clotting disorders. All women delivered vaginally. No maternal deaths occurred. In contrast to most authors, we present data showing that in four out of five cases the clotting system started to normalize before the uterus was emptied. We suggest that an expectant approach until recovery of the coagulopathy is safer than aiming at a quick delivery. After stabilization of the clotting disorder, one may then consider evacuation of the uterus, if need be by induction of labor.

Abruptio Placentae↗
PubMed1992

Maternal height and the outcome of labor in rural Tanzania.

The influence of maternal height (standardized for parity and birthweight) on obstetrical outcome is studied in 1095 women giving birth in Lugarawa hospital and 3869 women delivering in Mbozi hospital, both rural hospitals in the South Western Highlands of Tanzania. Short stature was found to increase the need for augmentation of labor in primiparae, the need for operative delivery (cesarean section/symphyseotomy) in all parity groups and the need for vacuum extraction in multiparae. The absence of such an effect of height on perinatal mortality is interpreted as the result of obstetric intervention. It is concluded that maternal height, which is easy to measure, remains a useful tool to predict difficult childbirth and cephalopelvic disproportion.

Birth Weight↗
PubMed1991

Vaginal birth after cesarean section in rural Tanzania.

Eighty-seven of 134 women with a history of previous cesarean section in two rural hospitals in Tanzania had a vaginal delivery after a trial of labor. The incidence of scar-rupture was high: in 9 of 134 cases (6.7%). Maternal death, however, did not occur. It is concluded that a trial of labor is justified, and that the risk of scar-rupture should be balanced with the risk of repeat operations.

Cesarean Section↗
PubMed1990

Safe motherhood: cesarean section or symphysiotomy?

The place of symphysiotomy in the management of cephalopelvic disproportion is discussed on the basis of the existing literature, reviewing maternal mortality and morbidity after symphysiotomy and the vaginal delivery rate in a subsequent pregnancy after a previous symphysiotomy. These are compared with the outcome of cesarean section performed in similar circumstances.

Cesarean Section↗
PubMed1989

[Vaginal delivery following cesarean section].

An analysis is presented of the outcome of labour in 462 women with a previous caesarean section, who delivered in the department of obstetrics of Leiden University Hospital in the period 1977-1986. Elective repeat section was performed in 26% of these women, while 83% of those accepted for a trial of labour had a vaginal delivery. In 196 women with a history of a previous caesarean section (1984-1986) a retrospective analysis was made of the influence of the indication for the previous caesarean section with respect of the outcome of labour in the following pregnancy. A trial of labour had the highest chance of success in those who had had a previous caesarean section because of a breech presentation. Sixty-five percent of women who had had a prior caesarean section because of cephalopelvic disproportion or failure to progress delivered by the vaginal route after a trial of labour. Foetal weight estimation by ultrasound could not predict the outcome of a trial of labour. It is concluded that a trial of labour after a previous caesarean section, even when the operation was performed because of cephalopelvic disproportion or failure to progress, is safe and rational.

Birth Weight↗
PubMed1989

Perinatal mortality in rural Tanzania.

Prolonged labour was the most frequent cause of perinatal death in a rural hospital in the south western highlands of Tanzania. After the introduction of an obstetric policy aiming to prevent prolonged labour by making use of the guidelines of the partogram, perinatal mortality was reduced from 71 to 39 per 1000 births. Baird's clinico-pathological classification is still considered a useful instrument for the discovery of avoidable factors in perinatal deaths. The concept of the partogram should be an integral part of the training of medical auxiliaries in the field of maternal and child health (MCH).

Delivery, Obstetric↗