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Biomedical subjects

P E Treffers

Publications and source records attributed to P E Treffers.

At least 19 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↗
PubMed1995

Physical work load and gestational age at delivery.

OBJECTIVE: To assess the impact of physical activity on the gestational age at delivery in women performing physical tasks in their jobs during pregnancy. METHODS: Qualified nurses at 15 weeks of pregnancy were asked through a questionnaire to describe the tasks in their regular job, the physical activities involved, and their exposure to other occupational stressors. The physical activities to be identified were walking, standing, lifting, stooping, squatting, and sitting. RESULTS: A high degree of daily physical work load during pregnancy seemed to be a significant predictor for the gestational age at delivery, whereas chemical and infectious agents were not. CONCLUSIONS: Physical work load during pregnancy should be diminished to avoid adverse effects on gestational age at delivery.

Alcohol Drinking↗
PubMed1994

Perinatal results of hemodynamic and conservative temporizing treatment in severe pre-eclampsia.

OBJECTIVE: To evaluate maternal and perinatal outcome of hemodynamic temporizing management in severe pre-eclampsia. DESIGN: Study group of 57 pre-eclamptic women, gestational age 35 weeks or less, treated with plasma volume expansion and vasodilatation under invasive hemodynamic monitoring, retrospectively matched with a control group treated in another center without volume expansion and invasive monitoring. RESULTS: In both groups pregnancy was prolonged with 10-11 days. Maternal morbidity was low in both groups. No complications of hemodynamic monitoring were observed. Perinatal mortality was not significantly different between the study group (7.1%) and the control group (14.3%). SGA-infants were significantly less frequent in the study group (9%) than in controls (33%). CONCLUSION: Temporizing treatment of patients with early severe pre-eclampsia, with or without plasma volume expansion and invasive hemodynamic monitoring, may reduce neonatal mortality and morbidity. The difference in birthweight between study group and control group may be an effect of the therapy or may be caused by selection bias. The perinatal outcome in the study group suggests that there may be a subgroup of patients who might benefit from hemodynamic treatment.

Cerebral Hemorrhage↗
PubMed1993

The Wormerveer study; perinatal mortality and non-optimal management in a practice of independent midwives.

In a prospective study in a group of 7980 pregnant women who booked in an independent midwife practice perinatal mortality was studied with the aim to assess non-optimal management. An internally generated audit proved not to be successful because of emotional involvement. A panel of independent experts seemed to be a better instrument to assess the quality of care. In 66 (75%) of all 89 cases complete consensus or near consensus was reached. In this group preventable factors were noticed in 29 cases (44%). In 30 cases (45%) the mortality was judged as inevitable. In 7 cases the information was insufficient. In the 29 cases with preventable factors, 12 cases concerned the skill of the obstetrician, seven cases the skill of the pediatrician, seven cases the skill of the midwife. In two cases the behaviour of the patient and in one case the skill of the general practitioner were blamed. Preventable factors are mainly present in decisions made during the prenatal period by the midwife (or general practitioner) and the obstetrician, and in care during labour and delivery and the postnatal period by the obstetrician and pediatrician. The care of the midwife during labour and delivery had little influence on preventable perinatal mortality. A further decrease of perinatal mortality may be achieved by analysis of the cases and continued education of all workers in perinatal care.

Humans↗
PubMed1993

The Dutch famine birth cohort study: design, validation of exposure, and selected characteristics of subjects after 43 years follow-up.

A historical birth cohort study of 1116 women born between August 1 1944 and April 15 1946 in the Wilhelmina Gasthuis hospital in Amsterdam, the Netherlands, was set up to study the short- and long-term effects of a limited period of extreme nutritional deprivation in the winter of 1944-1945 in the Western Netherlands. The degree of food deprivation is evidenced by a dramatic decline in third trimester pregnancy weight gain and infant birthweight. All women were traced and 84% (683/813) of survivors presently resident in the Netherlands agreed to be interviewed in their homes. There were no differences in characteristics at birth between interviewed and uninterviewed survivors. The women who were interviewed had 1299 offspring and were able to recall birthweight of all of them. Additional birthweight information from hospital and well-baby clinic (WBC) records is available for about half of the offspring. Since the famine was imposed on the entire population of a well-defined area, whose opportunities to obtain food elsewhere were severely restricted, and the women from this hospital cohort were predominantly lower middle class, the relationship between fetal nutrition and subsequent health outcomes in this cohort is not likely to be confounded by unmeasured attributes related to social class. In addition, selective losses to follow-up could be excluded, which makes the Dutch famine birth cohort a valuable resource for future studies in perinatal epidemiology.

Adult↗
PubMed1992

[Hysteroscopy].

Explore the source record for details and available documents.

Electrosurgery↗
PubMed1992

Jejunal atresia related to the use of methylene blue in genetic amniocentesis in twins.

OBJECTIVE: To calculate the incidence of jejunal atresia in newborns in The Netherlands. To study the relation between the occurrence of jejunal atresia and genetic amniocentesis to determine a possible iatrogenic cause for the unexpected high incidence of this anomaly in twins. DESIGN: Retrospective study. SUBJECTS: Eighty-nine consecutive twin pregnancies in which amniocentesis had been performed for prenatal diagnosis. In 86 methylene blue solution had been used to mark the amniotic cavity that was punctured first. MAIN OUTCOME MEASURE: The occurrence of jejunal atresia in one of the two twin infants. RESULTS: The incidence of jejunal atresia at birth in The Netherlands is estimated to be 1 in 14,000. This anomaly occurred in 17 out of 89 twin pregnancies (19%). In 15 of the 17 it was possible to determine which of the two children had been exposed to intra-amniotic methylene blue. In all 15 pregnancies, the infant exposed to the dye was suffering from jejunal atresia. CONCLUSION: A causal relation between the use of methylene blue in second trimester amniocentesis and the occurrence of jejunal atresia is strongly suggested. We recommend that no dyes should be injected into the amniotic sac.

Amniocentesis↗
PubMed1991

Place of delivery in The Netherlands: actual location of confinement.

Preferred and actual locations of confinement were compared in a group of 170 nulliparous women. Voluntary changes in preferred location for birth were rare and concerned only changes from hospital to home confinement. Obligatory changes due to referral to consultant obstetricians occurred frequently: 58.8% of the total sample. Fewer referrals were found for women with an initial preference for a home confinement (53%) than for those who preferred a hospital confinement (64%). Most referrals occurred in the group of older women initially in doubt about their preferred location for giving birth: 72%. The differences were not significant, however. To reveal differences between referrals and non-referrals, discriminant analysis was performed at the 18th week of gestation. The explained variance for the total group of referrals was 64.7%. Partially, the variables pertaining to the explained variance were the same as those related to a preferred hospital confinement. The explained variance for the group of referrals in which psychosocial influences were presupposed was not better, with the exception of referrals due to insufficient progress during labour: 76.4% of the variance could be explained at the 34th gestational week. When birth weight and amenorrhoea were included, these percentages increased to 79.0 and 84.8%, respectively.

Adult↗
PubMed1991

Incarceration of the retroverted gravid uterus: a report of four cases.

Four cases of incarceration of the retroverted gravid uterus are described. Typical observations were: a rather low fundal height at vaginal examination, no detectable uterine cervix, and the fetal presenting part deeply impacted in the pelvic cavity. One spontaneous correction in the third trimester is described. In general a cesarean section under general anesthesia is indicated. Preoperative recognition of retroversion is important and may prevent intraoperative complications. Three cases showed micturition problems in the second trimester. All pregnant women with second trimester micturition problems should be examined for a possible retroverted uterus.

Adult↗