[Rapid prenatal diagnosis of chromosomal abnormalities; limitations and possibilities].
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Chromosome Aberrations↗
Biomedical subjects
J G Nijhuis
Publications and source records attributed to J G Nijhuis.
[A request for caesarean section without a medical indication should ultimately be granted].
A request for the performance of an elective caesarean section should be discussed openly and the arguments pro and con clearly explained. If the woman persists in her request, it would seem advisable to consent. Respect for the 'intuition' of a pregnant woman who is not motivated in favour of a vaginal delivery can prevent the delivery from ending in a secondary caesarean that will be perceived as an extremely traumatic experience.
Cesarean Section↗
Prenatal diagnosis of bronchial atresia, early in pregnancy.
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Adult↗
Sequential triage in the first trimester may enhance advanced ultrasound scanning in population screening for trisomy 21.
OBJECTIVE: To design a trisomy 21 screening protocol for sequential triage in the first trimester, and to evaluate whether it reduces the need for advanced ultrasound scanning to such an extent that this could be dealt with by a limited number of well-trained sonographers only. METHODS: Screening results of 31 trisomy 21 affected pregnancies and 16 096 unaffected pregnancies from the first trimester screening program of Algemeen Medisch Laboratorium in Antwerp, Belgium, were used to define high-risk, intermediate-risk and low-risk groups. A serum screening result (age, pregnancy-associated plasma protein-A (PAPP-A) and free beta-human chorionic gonadotropin (beta-hCG)) of >or=1 : 30 and/or a nuchal translucency thickness (NT) measurement of >or= 3.5 mm were classified as high risk. A serum screening result of < 1 : 1000 together with an NT of < 3.5 mm were classified as low risk. Other results were considered intermediate risk, for which further advanced ultrasound screening would be indicated. This protocol was then evaluated prospectively in another population of 13 493 first-trimester pregnancies. RESULTS: Of the total population, 1.9% was identified as being high risk (14 trisomy 21 pregnancies and 222 unaffected pregnancies; prevalence, 1 : 17), 59.6% was identified as being low risk (three trisomy 21 pregnancies and 9615 unaffected pregnancies; prevalence, 1 : 3206) and 38.4% was identified as being intermediate risk (10 trisomy 21 pregnancies and 6190 unaffected pregnancies; prevalence, 1 : 620). A similar distribution was found in the prospective arm of the study. There was no reduction of overall screening performance compared with our current first-trimester combined screening program. The number of intermediate-risk pregnancies was sufficiently low as to enable advanced ultrasound scanning by well-trained sonographers only. CONCLUSION: In population screening for fetal trisomy 21, sequential triage in the first trimester can be achieved using very simple methods. Pregnancies at high or at low risk can be identified easily and the number of pregnancies at intermediate risk can be reduced sufficiently to enable advanced ultrasound scanning by well-trained sonographers only. A prospective study is needed to evaluate the performance of this approach and to compare its results with current combined or integrated screening algorithms.
Adult↗
Birth weight and neurodevelopmental outcome of children at 2 years of age after planned vaginal delivery for breech presentation at term.
OBJECTIVE: The purpose of this prospective cohort study was to determine whether planned vaginal delivery for the term singleton baby in breech position increases the risk of abnormal neurodevelopment at 2 years of age and to assess whether the effect is modified by birth weight. STUDY DESIGN: At 2 years of age, all nonrandomized children born in breech position during our participation in the Term Breech Trial were screened for abnormal neurodevelopment with the Ages and Stages Questionnaire. RESULTS: An Ages and Stages Questionnaire at 2 years of age was obtained in 183 of 203 children (90.1%). Twenty-eight percent of these children showed 1 or more abnormal Ages and Stages Questionnaire domains. There were no differences in the risk of having abnormal Ages and Stages Questionnaire domains between planned vaginal delivery and planned cesarean section (P = .99). There was, however, evidence of interaction between mode of delivery and birth weight, with significantly higher risk in neurodevelopmental delay in children with birth weight greater than 3500 g with planned vaginal birth (adjusted odds ratio for interaction term 3.37; 95% confidence interval 1.14 to 9.95). CONCLUSION: Based on the Ages and Stages Questionnaire results at 2 years of age, planned vaginal delivery is associated with an increased risk of neurodevelopmental delay at 2 years of age in term breech children with a birth weight greater than 3500 g.
Adult↗
Community-based screening for Down syndrome in the first trimester using ultrasound and maternal serum biochemistry.
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Community Health Services↗
[High perinatal mortality in the Netherlands compared to the rest of Europe].
In the Peristat-project, a European collaborative study, a set of indicators has been defined for monitoring perinatal health outcomes. For a group of 10 core indicators, with variables for subgroup analysis, national registry data from 15 European member states were collected and compared. The Netherlands was found to have the highest perinatal mortality in Europe: the foetal and neonatal mortality amounted to 7.4 and 3.5 per 1000 births, respectively. European countries differ in registration practices. Some countries do not register perinatal deaths occurring before a duration of amenorrhoea of 28 weeks. Therefore, the Peristat mortality data should be compared with 28 weeks of gestation as a cut-off point. With this cut-off point, The Netherlands has the second highest perinatal mortality. A number of factors may have contributed to this relatively high mortality, such as differences in registration practices, the profile of the Dutch childbearing population and the characteristics of Dutch perinatal care. The Netherlands has a relatively high proportion of older mothers, multiple births and mothers belonging to an ethnic minority. Also, Dutch neonatologists are known to be conservative in their treatment of premature newborns, which reduces their chances of survival. There is also less prenatal screening for congenital abnormalities in The Netherlands than in many other European countries. Further analysis of the Dutch data, as well as continued monitoring at the European level, can serve as a basis for future policy decisions to enhance the health of Dutch mothers and newborns.
Data Collection↗
Audit on nuchal translucency thickness measurements in Flanders, Belgium: a plea for methodological standardization.
OBJECTIVES: To audit nuchal translucency thickness (NT) measurements for fetal aneuploidy screening in Flanders, and to estimate the impact of small variations in NT measurement on the screening result of two first-trimester screening algorithms: maternal age + NT (Algorithm A), and maternal age + NT + pregnancy associated plasma protein-A + free beta-human chorionic gonadotropin (Algorithm B). METHODS: We used the database of first-trimester combined screening, as collected by the General Medical Laboratory AML in Antwerp, Belgium, between 1 January 2001 and 1 April 2004. Audit was performed by establishing a delta-NT distribution curve for one trainee of The Fetal Medicine Foundation (FMF) and for a group of 263 other sonographers, in comparison with the FMF reference values. Risks for fetal aneuploidy were calculated at a cut-off value of 1 : 300 for Algorithm A and 1 : 150 for Algorithm B. These risks were recalculated in both algorithms after a modeled increase of all NT values by 0.1 or 0.2 mm. RESULTS: In a total of 592 measurements performed by the FMF trainee, the 5th, 50th and 95th percentiles of delta-NT measurements were at -0.41, +0.03 and +0.68 mm, respectively. These values were close to the FMF reference values. The screen-positive rate for this set of data was 4.4% (26/592) in both algorithms. For the 12 555 measurements of the 263 other sonographers, the 5th, 50th and 95th percentiles of delta-NT were at -0.81, -0.14 and +0.73 mm, respectively, which clearly indicates underestimation of NT in the lower range. In this set of data the screen-positive rate was 3.5% for both algorithms (439/12 555 for Algorithm A and 436/12 555 for Algorithm B). Also in this group, 5% (59/1186) of negative screening results at maternal age > or = 35 years in Algorithm A became positive after a modeled 0.1-mm increase in NT, whereas this was only in 1.2% (134/11 369) of tests at maternal age < 35 years (P < 0.0001). The overall increase of screen-positive rate in Algorithm A after an NT modification of +0.1 mm was 1.2% (152/12 555), significantly more than in Algorithm B (86/12 555; 0.7%) (P < 0.0001). CONCLUSION: In Flanders, there is a systematic underestimation of NT in comparison with the FMF reference range. Attempts to change these measurements according to the FMF criteria are crucial. This will mainly influence the screening results of women at advanced maternal age and of NT-based algorithms without the use of other parameters.
Adult↗
Moderate neonatal morbidity after vaginal term breech delivery.
OBJECTIVE: Comparison of the results of term breech births in our clinic with the Term Breech Trial (TBT). MATERIAL AND METHODS: During the investigation period prospective data were collected on all deliveries of a term baby in breech presentation. Some pregnant women were included in the TBT and randomized in a planned cesarean section (CS)-group and a planned vaginal birth (VB)-group. The remaining non-randomized women were divided into a primary CS-group and a started VB-group. Neonatal and maternal mortality and morbidity were analyzed retrospectively, according to the intended mode of delivery. RESULTS: Neonatal or maternal mortality occurred in none of the groups. Neither in the randomized group nor in the non-randomized group were significant differences in serious neonatal and maternal morbidity observed between the intended cesarean section-group and the group that started vaginal delivery. However, in the non-randomized group, moderate neonatal morbidity was significantly lower in the primary CS-group than in the started VB-group. CONCLUSION: The differences in moderate neonatal morbidity support the conclusion of the TBT, that primary cesarean section may be safer for the term breech baby than a trial of vaginal labor.
Adult↗
Validity of the Hewlett-Packard actograph in detecting fetal movements.
OBJECTIVE: To detect fetal movements during non-stressed cardiotocography to evaluate the validity of the Hewlett-Packard Doppler ultrasound actograph in detecting fetal movements. METHODS: This was a prospective, observational study. Thirty healthy pregnant women were divided into two gestational age groups (Group I, 31 + 0 to 34 + 0 weeks, n = 15; Group II, 37 + 0 to 40 + 0 weeks, n = 15). A Hewlett-Packard M-1350-A actocardiograph was used to make recordings of 45 min for each woman. Fetal movements were also detected sonographically by an observer and they were recorded independently by the pregnant woman. Ninety consecutive 30-s periods were analyzed to study agreement between the three techniques. RESULTS: The mean total agreement for fetal activity plus quiescence between ultrasound and the actograph was 63.7% for Group I, and 72.2% for Group II. In cases of fetal activity only, these values were 45.8% and 47.6%, respectively. Total agreements between ultrasound and the pregnant woman were 74.0% and 79.0%, respectively, for Groups I and II. Cohen's kappa values for total agreement between ultrasound and actograph were 0.31 (95% CI, 0.27-0.36), indicating 'fair' agreement in Group I, and 0.43 (95% CI, 0.38-0.47), indicating 'moderate' agreement in Group II. CONCLUSIONS: Use of the Hewlett-Packard actograph may offer some additional information during routine cardiotocography. However, our results were disappointing; the technique appears not to be suitable for detailed recordings of fetal behavior, and may even be misleading when difficult cardiotocographic patterns have to be interpreted.
Adult↗
[The pregnant patient with acute liver disease].
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Adult↗
[Term breech presentation: an indication for cesarean section].
The results of the 'Term breech trial' (carried out at 121 centres in 26 countries, and in which 2088 women with a singleton foetus in breech presentation were randomly assigned to planned caesarean section or planned vaginal birth) indicate that in countries with low perinatal mortality rates, planned vaginal birth was associated with serious neonatal morbidity at least 12.5 times more often than was the case for planned caesarean section. The trial is methodologically sound. Unfortunately, no information on long-term neonatal morbidity is provided and the study is too small to assess maternal mortality. Moreover, the study provides no information on the consequences of a uterine scar for future pregnancies. However, as there are no other data from studies in the Netherlands, the results from this trial also have a bearing on Dutch practice. The pregnant mother of a term breech baby should be carefully informed about the results of this trial, prior to the preferred means of delivery being decided upon in consultation with her. A deliberate choice for an elective caesarean section based on a mere breech presentation is justified.
Breech Presentation↗
The responses to repeated vibroacoustic stimulation in a fetus with trisomy 18.
Observation of the fetal movement and fetal heart rate responses to repeated vibroacoustic stimulation might be useful as a measure to assess fetal well-being. Studies of abnormal fetuses are needed to gain insight in the spectrum of possible responses to stimulation. We present a case of a fetus with trisomy 18 that failed to respond to repeated stimulation.
Acoustics↗
Fetal habituation to vibroacoustic stimulation in uncomplicated postterm pregnancies.
OBJECTIVES: Testing of fetal habituation to repeated vibroacoustic stimulation might give additional information concerning the fetal condition and central nervous system (CNS) functioning in postterm pregnancies. This study is designed to investigate whether healthy postterm fetuses are able to habituate and if so, if the habituation pattern of postterm fetuses differs from that of term fetuses. STUDY DESIGN: Twenty women with an uncomplicated pregnancy beyond 41 weeks gestational age (GA) participated, and 37 women with a GA between 37 and 40 weeks served as controls. The vibroacoustic stimulus was repeatedly applied to the maternal abdomen above the fetal legs for a period of 1s every 30s. A fetal trunk movement within 1s of stimulus application was considered a positive response. Lack of response to four consecutive stimuli indicated habituation. The habituation rate is defined as the number of stimuli applied before the fetus stopped responding. Data were compared using Mann-Whitney U test. RESULTS: Of the 18 postterm fetuses in which the presence or absence of habituation could be established, 14 habituated and four persisted in responding. Twenty-six of the 32 term fetuses, in which the presence or absence of habituation could be established, habituated and six persisted in responding. The habituation rate varied widely in postterm (median of eight stimuli, quartile ranges of 6 and 18) as well as in term fetuses (median of 9.5 stimuli, quartile ranges of 6 and 15). There was no difference in median habituation rate between postterm and term fetuses. CONCLUSION: The ongoing maturation of the CNS in the last weeks of pregnancy appears not to be reflected in the fetal habituation pattern. Furthermore, the interfetal variability in habituation of healthy postterm fetuses is such that testing of habituation appears not to be suitable for the identification of the fetus at risk for an adverse neonatal outcome.
Acoustic Stimulation↗
Fetal habituation to vibroacoustic stimulation in relation to fetal states and fetal heart rate parameters.
OBJECTIVES: Fetal habituation to repeated stimulation has the potential to become a tool in the assessment of fetal condition and of the function of the fetal central nervous system (CNS). However, the influence of fetal quiescence and activity on habituation remains to be clarified. We studied habituation and the influence of fetal state and fetal heart rate (FHR) parameters on habituation in healthy term fetuses. SUBJECTS AND METHOD: We studied habituation in 37 healthy fetuses in two tests with an interval of 10 min. The vibroacoustic stimuli were applied to the maternal abdomen above the fetal legs for a period of 1 s every 30 s. A fetal trunk movement within 1 s after stimulation was defined as a positive response. Habituation rate is defined as the number of stimuli applied before an observed non-response to four consecutive stimuli. The FHR patterns (FHRP) of the 10 min observation period before and after the tests were visually classified. Fetal states were defined according to the FHRP. Baseline FHR, FHR variability and the number of accelerations were calculated in a subgroup of 25 fetuses. RESULTS: Of the 32 fetuses that responded normally during the first test, 26 habituated and six had persistent responses. The median habituation rate decreased significantly in the second test (P=0.001). There was no difference in habituation rate between fetuses that where initially in a quiet state and those in an active state. The FHR parameters before the first test and the difference between these FHR parameters before and after the test did not correlate with the habituation rate. CONCLUSIONS: Although the majority of healthy fetuses was able to habituate, the interfetal variability in habituation performance is such that testing of habituation seems not to be a sensitive tool for the assessment of the fetal CNS. This variability is neither the result of differences in fetal state nor of the various FHR parameters before testing, nor of the difference in change of FHR parameters arising from stimulation.
Acoustic Stimulation↗
Hypoxia in fetal lambs: a study with (1)H-MNR spectroscopy of cerebrospinal fluid.
In fetal lambs, severe hypoxia (SH) will lead to brain damage. Mild hypoxia (MH) is thought to be relatively safe for the fetal brain because compensating mechanisms are activated. We questioned whether MH, leading to mild acidosis, induces changes in cerebral metabolism. Metabolites in cerebrospinal fluid (CSF) samples, as analyzed by proton magnetic resonance spectroscopy, were studied in two groups of seven anesthetized near-term fetal lambs. In group I, SH leading to acidosis with an arterial pH <7.1 was achieved. In group II, MH with an intended pH of 7.23--7.27 was reached [start of MH (SMH)], and maintained during 2 h [end of MH (EMH)]. During SH, choline levels in CSF, a possible indicator of cell membrane damage, were increased. Both during SH and at EMH, CSF levels of lactic acid, alanine, phenylalanine, tyrosine, lysine, branched chain amino acids, and hypoxanthine were increased compared with control values and with SMH, respectively. At EMH, the hypoxanthine CSF-to-blood ratio was increased as compared with SMH. These results indicate that prolonged MH leads to energy degradation in the fetal lamb brain and may not be as safe as assumed.
Animals↗
Fetal learning and memory.
We used fetal habituation to repeated vibroacoustic stimulation to assess fetal memory. After the initial stimulus, we assessed the fetuses 10 min later and again after 24 h. 16 of 19 fetuses habituated rapidly to the stimuli at 10 min (p=0.004) and 24 h (p=0.042) after the initial test. We conclude, therefore, that fetuses are able to learn: they have a short-term memory of at least 10 min, and a long-term memory of at least 24 h.
Acoustic Stimulation↗
Perinatal audit on avoidable mortality in a Dutch rural region: a retrospective study.
OBJECTIVE: To analyse the mode and cause of perinatal mortality. SETTING: a rural Dutch region. STUDY DESIGN: Over a two-year period (1994-1995), data were collected in the 's Hertogenbosch region. A perinatal audit group investigated and classified the cause of death in an "intention to treat" and concensus model. We then analyzed who was responsible for the patient at the moment perinatal death occurred, or became inevitable. RESULTS: Out of 8509 newborns, 73 died between the 24th week of pregnancy till the 7th day post-partum (8.58 promille). Twenty-three cases (31.50%) were classified as probably or possibly avoidable. In the primary health care group (midwives, general practitioners) 6 out of 32 (18.75%), in the secondary care group (obstetricians) 15 out of 35 (44.86%) and in the tertiary care group 1 out of 4 (25.00%) were judged as probably or possibly avoidable. The degree of concensus in the perinatal audit committee was high (Kappa=0.9). IMPACT: The analysis of perinatal mortality identifies the cause of death and may help to improve perinatal health care. CONCLUSION: In this study, 31.55% of perinatal mortality was avoidable in the three levels of care. Intra-uterine growth retardation, congenital malformations and antepartum haemorrhage were the most determinant factors for perinatal mortality. The Dutch obstetrical care system as such, for example home deliveries, did not effect the perinatal mortality rate. Perinatal mortality rates presented by the Dutch Central Bureau of Statistics still shows a slight underregistration.
Adult↗