Major obstetric hemorrhage: a follow-up survey on quality of life of women and their partners.

INTRODUCTION: A description is given of the quality of life (QOL) of women who were treated with peripartum embolization or hysterectomy for major obstetric hemorrhage (MOH). METHODS: Questionnaires assessing QOL, combined with questionnaires and drawings assessing illness perceptions, were used to compare women with MOH to reference groups provided by the questionnaires. RESULTS: Women who experienced MOH have similar scores on QOL questionnaires compared to reference groups. Women treated with arterial embolization scored better than women treated with hysterectomy. Partners of women with MOH scored better on QOL questionnaires than reference groups. Drawings reflect the major emotional impact of MOH. DISCUSSION: MOH does not seem to have a negative effect on QOL 6-8 years after the event, although drawings and verbalizations indicate major emotional impact. More extensive follow-up is advised for early recognition of the need for psychological help. Women after embolization seem to have better QOL compared to women after hysterectomy.

Increasing incidence of postpartum hemorrhage: the Dutch piece of the puzzle.

INTRODUCTION: An increase of postpartum hemorrhage (PPH) has been reported in many high-income countries. In addition to this data, this study reports on trends in the incidence of PPH in the Netherlands in 2000-2013, and examines the extent to which temporal changes in risk indicators could explain a possible change in incidence of PPH. MATERIAL AND METHODS: We used data from the Dutch Perinatal Registry, which contains prospectively collected antenatal, peripartum and neonatal data of 95-99% of all women and neonates in the Netherlands. We selected births ≥22 weeks of gestation from January 2000 until December 2013. Changes in the incidence of PPH and its risk indicators were studied over time. Main outcome measure was PPH, defined as blood loss >1000 mL within 24 h following delivery. RESULTS: The data comprised 2 406 784 women. The incidence of PPH rose significantly from 4.1% in 2000 to 6.4% in 2013 (p < 0.0001). The incidence of previously identified risk indicators for PPH increased over time. Manual removal of placenta was strongly associated with PPH (OR 29.3, CI 28.8-29.8). The incidence of PPH-related blood transfusion decreased remarkably. CONCLUSIONS: In line with international observations, Dutch data suggest a considerable increase in the incidence of PPH which can only partly be explained by the studied risk indicators. The decreasing incidence of obstetric blood transfusion suggests an increased incidence of blood loss of 1000-1500 mL.

Puerperal uterine inversion in the Netherlands: a nationwide cohort study.

Puerperal uterine inversion is a severe but rare obstetric complication of yet unknown origin. In this two-year study we determine the incidence of this complication and we describe associated risk factors to expose its etiology. All cases of uterine inversion were included from a nationwide cohort study which contained all 98 hospitals with a maternity unit in the Netherlands. We reviewed the medical records of 15 patients, resulting an incidence of approximately 1 in 20 000 vaginal births. Fourteen cases (93.3%) were classified as low-risk pregnancies at booking. Nulliparous women were not overrepresented and the main associated factors were signs of prolonged labor followed by third stage manipulation. This study is the first population-based study for uterine inversion. With the reported associated factors and occurrence in women with a low-risk profile, we show that every birth attendant should be able to detect this rare but severe complication.

No reduction of manual removal after misoprostol for retained placenta: a double-blind, randomized trial.

OBJECTIVE: To test the effect of 800 µg of misoprostol orally on the prevention of manual removal of retained placenta. DESIGN: Multicenter, double-blinded, placebo-controlled, randomized trial. SETTING: One university and one non-university teaching hospital in the Netherlands. SAMPLE: 99 women with retained placenta (longer than 60 min after childbirth) in the absence of postpartum hemorrhage. METHODS: Eligible women were administered either 800 µg of misoprostol or placebo orally. MAIN OUTCOME MEASURES: Number of manual removals of retained placenta and amount of blood loss. RESULTS: Manual removal of retained placenta was performed in 50% of the women who received misoprostol and in 55% who received placebo (relative risk 0.91, 95% confidence interval 0.62-1.34). No difference in the amount of blood loss (970 vs. 1120 mL; p = 0.34) was observed between the two groups. CONCLUSIONS: Administration of 800 µg of oral misoprostol, one hour after childbirth, does not seem to reduce the number of manual removals of retained placentas. The time elapsing results in the delivery of 50% of the retained placentas at the expense of an increased risk of postpartum hemorrhage.

Good quality of life after emergency embolisation in postpartum haemorrhage.

Twenty-one women, who were treated for postpartum haemorrhage by embolisation of the uterine artery, filled in a series of questionnaires. The questionnaires assessed personality characteristics, illness perceptions, coping and quality of life (QoL). The women also made drawings of their uterus. The results suggest that women who experience emergency embolisation have good QoL at follow-up.

[Predicating imminent preterm labour based on a determination of foetal fibronectin in a vaginal smear]. / Voorspellen van dreigende vroeggeboorte door middel van bepaling van foetaal fibronectine in vaginaal vocht.

OBJECTIVE: To determine the prognostic value of foetal fibronectin and cervical length for predicting imminent preterm labour among Dutch women, who in the Netherlands normally undergo a digital examination of the cervix prior to referral to a hospital or university medical centre. DESIGN: Prospective observational cohort study. METHODS: Pregnant women with symptoms of preterm labour and a gestational age between 24 and 34 weeks were included. A fibronectin smear was taken from them and the cervical length was measured. Primary outcome was delivery within 7 days after inclusion. Sensitivity, specificity and a receiver-operating characteristics (ROC) curve were calculated. RESULTS: 13 (12%) of the 108 included patients delivered spontaneously within 7 days after inclusion. The fibronectin test had a sensitivity of 92% and specificity of 60%. The positive and negative predictive values were 27% and 98% respectively. For women who had undergone a digital examination prior to testing, the predictive value was slightly less but the difference was not significant. Although measurement of the cervical length scarcely had a predictive value, none of the patients with a cervical length above 35 mm delivered within 7 days. CONCLUSION: In women with an imminent preterm labour, a negative fibronectin test virtually ruled out delivery within 7 days. The fibronectin test can therefore also be used in the Dutch situation. In women with a cervix length greater than 35 mm, the chance of a preterm labour within 7 days is very small and a fibronectin test does not need to be performed in their case.

No short-term benefits of antenatal corticosteroid treatment in severely preterm growth restricted fetuses: a case-control study.

BACKGROUND: Antenatal corticosteroid administration to premature, growth restricted fetuses may not be beneficial and even have adverse effects on neonatal outcome. AIMS: To determine if preterm growth restricted fetuses benefit from antenatal corticosteroids. STUDY DESIGN: Retrospective cohort study. METHODS: All singleton pregnancies with growth restricted fetuses delivered at our department before 34 weeks' gestation or weighing less than 1500 g, between January 2001 and December 2005, were retrospectively reviewed. Neonatal outcome was compared between growth restricted fetuses (defined as abnormal flow patterns in umbilical and middle cerebral arteries) that received antenatal CST (CST group) and those who did not receive antenatal CST (no CST group). The administration of CST appeared to be quasi randomized. RESULTS: A total of 88 pregnancies fulfilled the inclusion criteria (CST group, n=54; no CST group, n=34). The incidence of neonatal respiratory distress syndrome in the CST and no CST group was 42% (22/54) and 50% (17/34), respectively (p=0.44). Neonatal mortality in the CST and no CST group was 9% (5/54) and 12% (4/34), respectively (p=0.73). The prevalence of adverse neonatal outcome (neonatal mortality, major neonatal morbidity or severe cerebral lesions) in the CST and no CST group was 28% (15/54) versus 24% (8/34), (p=0.62). CONCLUSIONS: Administration of CST to growth restricted preterm fetuses does not appear to be beneficial with respect to short term neonatal outcome.