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Biomedical subjects

M Pel

Publications and source records attributed to M Pel.

11 recordsLinked to original sources
PubMed1995

The Dutch obstetric intervention study--variations in practice patterns.

OBJECTIVE: To compare obstetric intervention rates between Dutch hospitals. METHODS: A total of 28,934 hospital births under secondary care (specialist care for medium-/high-risk pregnancies) in 1990 were analyzed in a stratified, random sample of Dutch hospitals based on the records of the Dutch Netherlands perinatal database. Comparisons were made of the intervention rates between hospitals. RESULTS: The intervention rates of the various hospitals differed widely. The most striking difference was in the cesarean section (CS) rate for non-vertex first twins, with a range of 0-100% and a mean rate of 47.6%. On average a CS for a term breech was performed in 30.8% of cases and sedation or analgesics were administered in 16.2% of cases. The mean rate of episiotomy for a term breech was 71.5%, the lowest rate being 18.8%. CONCLUSION: Our results show relatively low intervention rates with considerable interhospital variation.

Birth Weight↗
PubMed1995

Provider-associated factors in obstetric interventions.

OBJECTIVE: To assess which factors influence provider-associated differences in obstetric interventions. STUDY DESIGN: A survey of obstetricians and co-workers in a sample consisting of 38 Dutch hospitals was taken, using a questionnaire that contained questions about personal and hospital-policy data, and 19 clinical problems with a choice between intervention and non-intervention. From the clinical problems an Intervention Score was assembled. The influence of the personal and hospital-policy items on this Intervention Score was studied by analysis of variance. RESULTS: Overall the Intervention Score was low, with considerable interindividual variation. Four personal/hospital items influenced the Intervention Score: the teacher could affect the score in either direction; the increasing age of the obstetrician and routine electronic fetal monitoring had an increasing effect; employment of midwives had a decreasing effect. Other factors, including litigation, had no effect. CONCLUSION: Supplier-induced differences do exist in obstetric interventions and are influenced by personal and hospital-policy factors.

Adult↗
PubMed1994

Pregnancy and paroxysmal nocturnal hemoglobinuria.

A patient is described who developed symptoms of paroxysmal nocturnal hemoglobinuria (PNH) in her first pregnancy. This was uneventful except for a spontaneous preterm delivery. The second pregnancy was complicated by severe anemia and a hemolytic crisis with Budd-Chiari syndrome at 31 weeks' amenorrhoea. Delivery was again preterm and was the result of induced labour after premature rupture of membranes at 34 weeks. Literature shows a high maternal mortality among PNH patients (5.8%). The most common cause of death is liver vein thrombosis (Budd-Chiari syndrome). Fetal wastage (30%) and prematurity rate (16%) are also high. Recommendations for follow-up and therapy are given such as anticoagulation therapy, platelets and washed erythocytes transfusions, screening for Budd-Chiari syndrome and infections.

Adult↗
PubMed1993

[Poverty and ignorance: puerperal fever in the Amsterdamse Binnengasthuis in 1845].

The 1845 annual report of the maternity ward of the Amsterdam Binnengasthuis gives an insight into the obstetric knowledge and developments at that time, with emphasis on puerperal fever. Since the introduction of clinical training of medical students in 1828, maternal mortality had risen from 2.6% to 9.0%. In the year reviewed, 1845, maternal mortality was 8.6%. The report concerns 395 indigent and malnourished women. Rickets was frequent. Delivery, presentation of the children, complications, operative deliveries and outcome of the children are described. Perinatal mortality was 12.5%. In the original text, an impressive epidemic of puerperal fever in the first 4 months of the year is described. It also gives us an authentic insight into the views on the dissemination of puerperal fever, both the 'epidemic' (influence of cold weather etc.) and the 'contagionistic' view (dissemination by miasmata: evaporations from the diseased women). C.B. Tilanus Sr. (professor of obstetrics), reacted tepidly to Semmelweis' discoveries.

Disease Outbreaks↗
PubMed1993

[Prenatal treatment of alloimmune thrombocytopenia using high-dosage IgG].

Alloimmunization of the mother against foetal alloantigens can cause neonatal alloimmune thrombocytopenia (NAITP). The recurrence rate is high (90%). The thrombocytopenia in subsequent children is often more severe. Most feared are intracranial haemorrhages (ICH). Current diagnostics indicate that ICH often occurs in utero or during labour. Postnatal therapy is therefore of limited value. We treated three women who had had earlier newborns with severe NAITP, in 5 subsequent pregnancies with weekly high dose intravenous IgG from week 30-34. Four newborns of two women had no thrombocytopenia at birth. Only in one child was the NAITP as severe as in the previous affected sibling. We conclude that antenatal therapy with weekly high dose intravenous IgG is safe and often effective. In utero transfusions are indicated only in exceptional cases.

Blood Group Incompatibility↗