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Biomedical subjects

S A Scherjon

Publications and source records attributed to S A Scherjon.

At least 19 recordsLinked to original sources
PubMed2006

Differential distribution of CD4(+)CD25(bright) and CD8(+)CD28(-) T-cells in decidua and maternal blood during human pregnancy.

During pregnancy several maternal and fetal mechanisms are established to prevent a destructive immune response against the allogeneic fetus. Despite these mechanisms, fetus specific T-cells persist throughout gestation but little is known about the regulation of these T-cells. Recently, CD4(+)CD25(+) regulatory T-cells have been identified in human decidua. Human decidua forms the maternal part of the fetal-maternal interface and is subdivided in two distinct regions: the decidua (d.) basalis and the decidua (d.) parietalis. The aim of this study was to determine the distribution of specific T-cell subsets in d. basalis and d. parietalis in early and term pregnancy, with a special emphasis on the presence of CD4(+)CD25(bright) (regulatory) T-cells and CD8(+)CD28(-) (suppressor) T-cells. In addition, we compared phenotypic characteristics of decidua derived T-cell subsets with maternal peripheral blood (mPBL) T-cells and T-cells from non-pregnant controls. We identified significantly higher percentages of CD4(+)CD25(bright) and CD8(+)CD28(-) T-cells in decidua compared to peripheral blood suggesting an important role for these T-cell subsets locally at the fetal-maternal interface. The major differences in T-cell subset distribution and the presence of additional phenotypic differences between T-cells in d. basalis, d. parietalis and mPBL may reflect specific immunomodulatory functions of these T-cell subsets at these different sites during pregnancy.

CD28 Antigens↗
PubMed2005

[Breech presentation at term: the caesarean section that is routinely advised is ultimately not safe for the child].

Recently, the results have become available on both the neonatal and the maternal outcome of deliveries after randomisation in the Term breech trial. At 2 years, in contrast to the original results in which perinatal death and serious neonatal morbidity were higher in the planned vaginal delivery group, no differences were evident in the combined outcdme variable, including death after delivery and neurodevelopmental delay. There were also no apparent differences between the two groups in neurodevelopmental abnormalities as screened by the ASQ postal enquiry. These are the most important findings that should be discussed with the parents during counselling regarding the mode of delivery of a foetus in breech presentation.

Adult↗
PubMed2005

Factor VIII levels and the risk of pre-eclampsia, HELLP syndrome, pregnancy related hypertension and severe intrauterine growth retardation.

OBJECTIVE: Recently, acquired as well as genetic prothrombotic factors are associated with thrombotic events. These factors have also been related to conditions of uteroplacental insufficiency such as pre-eclampsia, HELLP syndrome and severe intrauterine growth restriction (IUGR). The aim of this study was to determine whether elevated factor VIII levels are associated with uteroplacental insufficiency, in particular pre-eclampsia, HELLP syndrome or pregnancy-induced hypertension and intrauterine growth retardation. METHODS: Plasma samples of 75 women with a history of pregnancy complicated by pre-eclampsia, HELLP syndrome, pregnancy induced hypertension or intrauterine growth restriction were tested for factor VIII:C (FVIII:C) levels at a minimum of 10 weeks post-partum. Laboratory results were compared to factor VIII:C levels found in a healthy control group of 272 women. RESULTS: Mean factor VIII:C levels were similar at 123 IU/dl in both the patient group and the controls. In a logistic regression model, after adjusting for age and blood group, no effect of factor VIII:C levels on the risk of pregnancy complications was observed, with the exception of IUGR with (OR 2.9, CI 1.0-8.7) or without hypertension (OR 2.0, CI 0.7-6.4). CONCLUSION: If the elevated level of factor VIII would be the sole factor responsible for the increased risk observed, one would expect to find an effect of blood group on risk as well (blood group being an important determinant of FVIII:C). While no such effect could be shown a causal relationship between elevated levels of factor VIII and conditions of uteroplacental insufficiency such as pre-eclampsia, HELLP syndrome, pregnancy-induced hypertension and IUGR is not very likely.

ABO Blood-Group System↗
PubMed2003

Intervention rates after elective induction of labor compared to labor with a spontaneous onset. A matched cohort study.

INTRODUCTION: Elective induction of labor has become a widely used procedure in obstetrics. A number of studies have shown an increased incidence of operative deliveries. The objective of this study was to evaluate the rate of interventions in our hospital, including operative delivery. METHODS: A matched cohort study in which labor of 122 electively induced women and 122 women with labor with a spontaneous onset were analyzed retrospectively. These women were matched for parity and gestational age. RESULTS: Pain relief, fetal scalp blood sampling and operative deliveries were recorded more frequently in the electively induced labor group. Cesarean delivery was found in 15% of women with induced labor, and in 1% of labors with a spontaneous onset (relative risk 18 (95% CI 2.4-132.7)). No differences were found in neonatal outcomes. CONCLUSIONS: Elective induction of labor leads to increased intervention rates during labor. The rate of cesarean delivery is high, particular in nulliparous women and multiparous women without a previous vaginal birth.

Adult↗
PubMed2001

Low dose sulprostone for termination of second and third trimester pregnancies.

OBJECTIVE: The purpose of this study is to assess the effectiveness and safety of sulprostone (nalador) for labour induction in the event of foetal death or foetal malformations. STUDY DESIGN: Retrospective analysis of 284 women with intrauterine foetal death (n=137), or foetal abnormalities (n=147), who underwent labour induction with sulprostone in a continuous dose of 1microg/min intravenously. RESULTS: All but three women had a successful vaginal delivery. The median induction-expulsion interval was significantly shorter (12h) in the foetal death group compared to the foetal malformation group (25h). Two uterine ruptures were recorded, one in a woman with a uterine anomaly, and one in a woman with a previous caesarean section. There were no other complications. Gestational age had a significant influence on spontaneous expulsion of the placenta: before 24 weeks 55%, and after 24 weeks 82% spontaneous expulsion. For the chance of a neonate born with signs of life, parity was the only significant determinant. CONCLUSIONS: The use of intravenous sulprostone in a low continuous dose is both effective and safe. In addition, this study does not support former opinions that smoking and advanced maternal age are contraindications.

Abortifacient Agents, Nonsteroidal↗
PubMed2001

The severity of immune fetal hydrops is predictive of fetal outcome after intrauterine treatment.

OBJECTIVE: This study was undertaken to test the hypothesis that the degree of immune fetal hydrops predicts outcome in red blood cell-alloimmunized pregnancies. STUDY DESIGN: In an 11-year period, 213 fetuses received 599 intrauterine transfusions. The outcome of 208 pregnancies, including two pairs of twins, was analyzed in a retrospective study. Eighty fetuses demonstrated ultrasonographic signs of hydrops at the start of treatment; 42 of these were classified as mildly hydropic and 38 were classified as severely hydropic. Reversal of hydrops as a result of treatment, survival, and neonatal morbidity was studied. RESULTS: The overall survival rate of fetuses with hydrops was 78%. Of the fetuses with mild hydrops, 98% survived, whereas in cases of severe hydrops the survival rate was 55%. Intrauterine reversal of hydrops occurred in 65% of the fetuses with hydrops. The reversal rate was 88% in fetuses with mild hydrops and 39% in fetuses classified as severely hydropic. After reversal of hydrops, almost all of the fetuses survived (98%), whereas in cases of persistent hydrops outcome was unfavorable, with a survival rate of 39% for all fetuses and 26% for fetuses classified as severely hydropic. CONCLUSION: In contrast with severe hydrops, there is a high rate of reversal of mild hydrops after adequate treatment. In our study 98% of fetuses survived after reversal of hydrops. To improve the outcome of red blood cell-alloimmunized pregnancies, early diagnosis of fetal anemia and referral to a specialized center are important; these steps enable the start of intrauterine treatment when hydrops is absent or still mild.

Blood Transfusion, Intrauterine↗
PubMed2000

Benefits and risks of fetal red-cell transfusion after 32 weeks gestation.

OBJECTIVE: To compare the outcome after intrauterine transfusion (IUT) between fetuses treated before and those treated after 32 weeks gestation. SETTING: National referral center for intrauterine treatment of red-cell alloimmunization in The Netherlands. STUDY DESIGN: Retrospective evaluation of an 11 year period, during which 209 fetuses were treated for alloimmune hemolytic disease with 609 red-cell IUTs. We compared fetal and neonatal outcome in three groups: fetuses only treated before 32 weeks gestation (group A, n=46), those treated both before and after 32 weeks (group B, n=117), and those where IUT was started at or after 32 weeks (group C, n=46). RESULTS: Survival rate was 48% in group A, 100% in group B, and 91% in group C. Moreover, fetuses in group A were hydropic significantly more often. Short-term perinatal loss rate after IUT was 3.4% in the 409 procedures performed before 32 weeks and 1.0% in the 200 procedures performed after 32 weeks gestation. CONCLUSION: Perinatal losses were much more common in fetuses only treated before 32 weeks gestation. Two procedure-related perinatal losses in 200 IUT after 32 weeks remain a matter of concern because of the good prospects of alternative extrauterine treatment.

Blood Transfusion, Intrauterine↗
PubMed2000

Association of stress during delivery with increased numbers of nucleated cells and hematopoietic progenitor cells in umbilical cord blood.

OBJECTIVE: Umbilical cord blood can be used as a source of bone marrow repopulating cells for allogeneic stem cell transplantation. Large variations in the frequencies of white blood cells and hematopoietic progenitor cells have been found for umbilical cord blood. These variations may be due in part to specific circumstances during labor and delivery. STUDY DESIGN: In this study we analyzed the relationship between stress factors occurring during parturition and the frequencies of nucleated cells, leukocyte subsets, CD34(+) cells, and hematopoietic progenitor cells, as determined in semisolid medium cultures of umbilical cord blood. RESULTS: We observed that a prolonged first stage of labor resulted in increases in the numbers of nucleated cells, granulocytes, CD34(+) cells, and hematopoietic progenitor cells in umbilical cord blood. Evaluation of parameters that indicate stress of the infant during delivery demonstrated higher numbers of nucleated cells, granulocytes, CD34(+) cells, and hematopoietic progenitor cells in umbilical cord blood from children with lower venous pH. CONCLUSION: Longer duration stress during delivery increased the numbers of nucleated cells, granulocytes, CD34(+) cells, and hematopoietic progenitor cells, possibly by causing mobilization of various cell populations by endogenous cytokines. As long as umbilical cord blood harvesting does not interfere with the delivery, umbilical cord blood collected after stressful deliveries may provide optimal units for hematopoietic stem cell transplantation.

Antigens, CD34↗
PubMed1998

Neurodevelopmental outcome at three years of age after fetal 'brain-sparing'.

Intrauterine growth restriction (IUGR), occurring preterm, may be related to impaired neurodevelopmental outcome. We measured neurodevelopmental outcome (Hempel examination) at the age of three years in a cohort of infants born between 26 and 33 weeks in 1989. Fetuses were studied haemodynamically, using Doppler ultrasound. The ratio between the umbilical and the cerebral artery Pulsatility Index (U/C ratio) was calculated. This is a measure of redistribution of fetal blood preferentially to the brain and this may be a marker of fetal adaptation to placental insufficiency. Impaired fetal growth was also measured by the fetal growth ratio. Neonatal cranial ultrasound was performed to document intracranial haemorrhages and/or ischaemia. From the original cohort of 106 infants, 96 (91%) infants were examined at three years. After adjustment for obstetric variables, adverse Hempel outcome was related to neonatal cranial ultrasound abnormality and low head circumference at three years. Neither the U/C ratio nor fetal growth were independently associated with Hempel outcome. Fetal 'brain-sparing' in IUGR appears to be a benign adaptive mechanism preventing severe brain damage.

Brain↗
PubMed1998

Obstetric outcome of elderly low-risk nulliparae.

OBJECTIVE: To compare referrals and reasons for referral during pregnancy and labor, mode of delivery and obstetric outcome of first births in women 35 years and older with women 20-30 years old. METHODS: A prospective cohort study was performed of 146 elderly and 306 younger nulliparae in seven independent midwives' practices in and around Amsterdam. RESULTS: No significant differences in referrals were found between the two compared groups. After selection during pregnancy, obstetric outcome was not different between the groups. A higher percentage of episiotomies was found in the elderly group, compared to the younger group. CONCLUSIONS: After proper selection during pregnancy, the elderly nullipara under the care of a midwife does not have an increased risk of fetal distress or other emergency factors, compared to the younger nullipara. However, high referral rates during labor - both of younger and older women - were observed in this study.

Adult↗
PubMed1998

Placental anatomy, fetal demise and therapeutic intervention in monochorionic twins and the transfusion syndrome: new hypotheses.

OBJECTIVE: Monochorionic twins with circulatory sharing have an incompletely understood response to acute hemodynamic events. We relate placental vascular anatomy with, first, the response to (a) acute fetal demise and (b) laser interrupted placental anastomoses and, second, the efficacy of current and possibly future therapeutic interventions in twin-twin transfusion syndrome. DESIGN: Hemodynamic response to acute fetal demise and laser interrupted anastomoses is analysed using the model previously developed for monochorionic twins. Efficacy of therapeutic interventions in twin-twin transfusion syndrome is analysed by combining the estimated incidence of placental anastomotic patterns with three previously proposed pathophysiologic mechanisms. RESULTS: Fetal demise may cause sequelae for the co-twin in all anastomotic patterns except unidirectional arteriovenous and single venovenous anastomoses which are predicted to be hemodynamically harmless. In twin-twin transfusion syndrome, laser interruption of all anastomoses mitigates further transfusion. This is of benefit for the twins in equally but not in unequally shared placentas. Analysis predicts that approximately 75% fetal survival could be achieved interrupting only arteriovenous anastomoses. Amniocentesis may only prolong pregnancies that lack progressively increasing discordance, assuming that placental anastomoses remain patent following polyhydramnios. This proposed mechanism of action predicts current therapeutic efficacy accurately and could explain the significantly higher reported serious morbidity compared with laser (15/81 = 19+/-5% versus 4/146=3%, P=0.00004). However, if therapeutic interventions could match the syndrome's individual placental anatomy, the analysis suggests approximately 10-15% laser related mortality (premature rupture of membranes) and <3% severe morbidity could possibly become achievable goals. CONCLUSION: Our predictions allow clinical testing. This information may contribute to an improved management of monochorionic twins.

Amniocentesis↗
PubMed1997

Elderly nulliparae in midwifery care in Amsterdam.

OBJECTIVE: to compare labour complications, after an uncomplicated pregnancy, of first births in women 35 years and older with women 20-30 years old. DESIGN: an explorative prospective cohort study. SETTING: four independent midwives' practices in Amsterdam. PARTICIPANTS: a group of 49 elderly nulliparae was compared with a group of 99 younger nulliparae. MEASUREMENTS AND FINDINGS: percentage of referrals and reasons for referral during pregnancy and labour, mode of delivery and obstetric outcome. KEY CONCLUSIONS: no significant differences in referrals were found between the two compared groups. Obstetric-outcome was not different between the groups, except for a lower birthweight in the elderly group. A trend is seen for a raised percentage of referrals during labour in the older group. This is almost completely explained by a failure to progress during first and second stages of labour. Related to this was a trend for an increased incidence of caesarean section in the older group of women. IMPLICATIONS FOR PRACTICE: after selection, the elderly nullipara, under the care of a midwife, does not have an increased risk of fetal distress or other emergency factors compared to the younger nullipara. However, the referral rates during labour, both of younger and older women, are high.

Adult↗
PubMed1997

Twin-twin transfusion syndrome. Three possible pathophysiologic mechanisms.

OBJECTIVE: To propose a classification of twin-twin transfusion syndrome based upon three categories of placental anastomotic patterns. STUDY DESIGN: A mathematical model developed to compute fetal blood volume in monochorionic twins combines fetoplacental circulation with net fetofetal transfusion along placental anastomoses. We included (1) unequal cotyledonic sharing, assuming that smaller fractions cause smaller twins with lower blood pressure, and (2) significantly decreasing anastomotic resistance, combining Poiseuille's law with placental anastomotic growth. Fetoplacental compensatory mechanisms were not studied. RESULTS: First, unidirectional arteriovenous anastomoses produce steadily increasing fetal discordance by small anastomotic blood flow. Second, arteriovenous plus compensating anastomoses (venoarterial, arterioarterial, venovenous) produce fetal discordance followed by a dynamic steady state of minimal net fetofetal transfusion and large anastomotic flow. This circumstance mitigates further discordant growth. Third, unequal cotyledonic sharing plus superficial compensating anastomoses (arterioarterial, venovenous) produce fetal discordance followed by a steady state of equal fetal growth and small anastomotic flow. The model predictions include spontaneous disappearance and reversal of discordance. Serial measurement of fetal growth patterns and anastomotic flow could identify the syndrome's underlying pathophysiology. CONCLUSION: Testing the model predictions by relating clinical presentation with placental anatomy could increase our understanding and direct diagnostic and therapeutic strategies to match the underlying placental anatomy.

Arteriovenous Anastomosis↗
PubMed1996

Fetal brain sparing is associated with accelerated shortening of visual evoked potential latencies during early infancy.

OBJECTIVE: Our purpose was to assess the effects that fetal growth restriction exerts on the myelination of the developing brain. STUDY DESIGN: Fetal haemodynamic centralization, an adaptive strategy to growth restriction caused by placental insufficiency, was determined by Doppler ultrasonography. Infants with a raised ratio between umbilical artery pulsatility index and cerebral artery pulsatility index are severely growth restricted. Visual evoked potentials give information on the degree of brain myelination. Shortening of visual evoked potential latencies is a normal feature of myelination. In a consecutive series of 105 Neonates, visual evoked potentials were recorded at the corrected ages of 6 months and 1 years. Correction for possible confounders, such as cranial ultrasonographic findings, gestational age, and head circumference, was performed. RESULTS: At 6 months, infants with a raised umbilical artery/cerebral artery pulsatility index ratio have shorter visual evoked potential latencies. Opposite of neonates with a normal umbilical artery/cerebral artery ratio, they show no postnatal maturational shortening of visual evoked potential latencies. CONCLUSION: Accelerated neurophysiologic maturation, found in infants with a high umbilical artery/cerebral artery ratio, might be the result of a beneficial adaptive process to severe fetal growth restriction.

Brain↗
PubMed1994

Neonatal cerebral circulation in relation to neurosonography and neurological outcome: a pulsed Doppler study.

In the pathogenesis of neonatal intracranial pathology and adverse neurologic outcome, severe instability of the neonatal cerebral circulation might play an important role. To examine this hypothesis the relationship was explored between intracranial pathology as detected by neurosonography during the first week of life, changes in cerebral blood flow velocity (CBFV) as measured by Doppler ultrasound in the same period and neurologic outcome, as measured by standardized tests during the first year of life. A group of 128 infants born after a pregnancy duration between 25 2/7 and 32 6/7 weeks was studied. In 40% of the infants, the time of occurrence of both types of intracranial pathology was within 1 hour after birth. No relation could be demonstrated between this occurrence and CBFV. Also after the appearance of intracranial pathology no specific changes in CBFV were seen. CBFV was associated with neurological outcome at term age. However, CBFV did not predict outcome of neurological examination at 6 and 12 months of corrected age. Intracranial hemorrhages were associated with abnormal neurological outcome at all assessments. Ischemic lesions were only associated with adverse outcome at 12 months of age.

Blood Flow Velocity↗