Biomedical subjects

P W van Dongen

Publications and source records attributed to P W van Dongen.

At least 19 recordsLinked to original sources

PubMed2001

History and use of oxytocics.

The most widely known oxytocic drug that can be used for the induction of labor or post-partum is oxytocin. In 1954, the american biochemist Vincent du Vigneaud was the first to describe an octapeptide amide with the hormonal activity of oxytocin. One year later, he was able to synthesize this octapeptide amide. In the same year he received the Nobel prize for his work in the field of biochemistry. A reprint of his brilliant publication is reproduced [with kind permission of the editors of the J Am Chem Soc]. With slight changes in structure, du Vigneaud was able to synthesize not only oxytocin, but also vasopressin. In our paper, however, we will focus on oxytocin only, as it is this synthetic hormone that has gained considerable importance in obstetrics. It is used for prevention of PPH as well as for induction of labour.

Female↗

PubMed2000

The Zavanelli manoeuvre in shoulder dystocia: case report and review of published cases.

A case of severe shoulder dystocia is reported in which, after other methods had failed, cephalic replacement succeeded but was very difficult. The infant suffered severe damage. A review of methods to relieve shoulder dystocia is given, with special attention to published cases of the Zavanelli manoeuvre. It could only be used when all other methods fail.

Adult↗

PubMed1999

Hypermobility and peripartum pelvic pain syndrome in pregnant South African women.

OBJECTIVE: To determine the incidence and correlation of joint hypermobility (HM) and peripartum pelvic pain (PPPP) in an homogeneous pregnant South African population. STUDY DESIGN: A cross-sectional study among Cape Coloured pregnant women. Joint mobility was measured by Beighton score; PPPP with a specially developed PPPP score. RESULTS: Using the Beighton scores with a cut-off point of HM > or = 5/9, only 4.9% of the 509 pregnant women were hypermobile. Hyperextension of the elbow was the largest contributor to HM (35.4%). No correlation of HM with the incidence of PPPP was established. Only 20 very mild cases of PPPP were recorded. Back pain increased significantly during pregnancy to a mean of 38%. Right handedness occurred in 95.9%. No significant relation was found between HM and the non-dominant side. CONCLUSION: Hypermobility in pregnant Cape Coloured women was surprisingly low (4.9%) with a decrease with age, but no increase during pregnancy. Peripartum pelvic pain is virtually absent and has no correlation with joint laxity. Back pain increased during pregnancy to a mean of 38%. Right handedness was high (96%) in comparison with the world-wide figure of 85%. No correlation was found between the dominant body side and hypermobility.

Adolescent↗

PubMed1998

Ascending dose tolerance study of intramuscular carbetocin administered after normal vaginal birth.

OBJECTIVE: To determine the maximum tolerated dose (MTD) of carbetocin (a long-acting synthetic analogue of oxytocin), when administered immediately after vaginal delivery at term. MATERIALS AND METHODS: Carbetocin was given as an intramuscular injection immediately after the birth of the infant in 45 healthy women with normal singleton pregnancies who delivered vaginally at term. Dosage groups of 15, 30, 50, 75, 100, 125, 150, 175 or 200 microg carbetocin were assigned to blocks of three women according to the continual reassessment method (CRM). RESULTS: All dosage groups consisted of three women, except those with 100 microg (n=6) and 200 microg (n=18). Recorded were dose-limiting adverse events: hyper- or hypotension (three), severe abdominal pain (0), vomiting (0) and retained placenta (four). Serious adverse events occurred in seven women: six cases with blood loss > or = 1000 ml, four cases of manual placenta removal, five cases of additional oxytocics administration and five cases of blood transfusion. Maximum blood loss was greatest at the upper and lower dose levels, and lowest in the 70-125 microg dose range. Four out of six cases with blood loss > or = 1000 ml occurred in the 200 microg group. The majority of additional administration of oxytocics (4/5) and blood transfusion (3/5) occurred in the dose groups of 200 microg. All retained placentae were found in the group of 200 microg. CONCLUSION: The MTD was calculated to be at 200 microg carbetocin.

Abdominal Pain↗

PubMed1998

Gunshot uterine rupture: a case report.

A case report of gunshot uterine rupture from which the mother and fetus survived is presented for the first time. Management was guided by pre-operative ultrasound diagnosis of traumatic anhydramnios.

Adult↗

PubMed1998

Successful fetal outcome after exposure to idarubicin and cytosine-arabinoside during the second trimester of pregnancy--a case report.

Chemotherapeutic agents administered to the mother during pregnancy may severely jeopardize the fetus. We describe a newborn girl who had been exposed to idarubicin and cytosine-arabinoside during the second and third trimesters of pregnancy due to treatment of newly diagnosed acute myeloid leukemia in the mother. The child had no structural congenital abnormalities. Adverse effects observed were prematurity, growth retardation, mildly disturbed transaminases and erythroblastosis, all of which were self-limiting with no permanent sequelae.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed1998

Ehlers-Danlos syndrome and type III collagen abnormalities: a variable clinical spectrum.

Ehlers Danlos syndrome (EDS) comprises ten types. EDS IV is the most severe type because of its often lethal complications, such as arterial rupture. EDS IV is caused by an abnormality of collagen type III as a result of mutations in the corresponding gene COL3A1. A collagen type III abnormality is also seen in patients with EDS without the classical severe EDS IV phenotype. We report on 11 patients with type III collagen abnormality and normal collagen V in whom clinically EDS II, III, and IV were diagnosed. There is no correlation between the type of collagen III anomaly and the clinical phenotype. It is concluded that type III collagen abnormality may lead to a phenotypic spectrum and that it does not predict the severity and course of the disease.

Adult↗

PubMed1998

Ergot alkaloids. Current status and review of clinical pharmacology and therapeutic use compared with other oxytocics in obstetrics and gynaecology.

Ergot alkaloids are well known preparations. Ergot alkaloids used in obstetrics and gynaecology are ergometrine (ergonovine; EM), methylergometrine (methergine; ME) and bromocriptine. The pharmaceutical properties of ME EM) are critical. To guarantee stability, ME and EM ampoules should be stored in a cool, dark place. ME and EM tablets are unstable in all conditions and they show an unpredictable bioavailability, which prevents oral use of the drugs for any purpose. ME and EM are known for their strong uterotonic effect and, compared with other ergot alkaloids, for their relatively slight vasoconstrictive abilities. ME and EM do have a place in the management of the third stage of labour as they are strong uterotonics. They act differently from oxytocin and prostaglandins, and have different adverse effects. Oxytocin should be used as prophylaxis or a the drug of first choice; next, ME or EM should be used, and if none of these drugs produce the desired effects, prostaglandins should be used to control bleeding. Ergot alkaloid use in gynaecology has been limited and today is discouraged even in essential menorrhagia. It is suggested that EM and ME be used (parenterally) only in first trimester abortion curettage, to reduce blood loss. Bromocriptine has been used for lactation suppression. However, alternatives such as cabergoline, which possess fewer adverse effects, are now available and therefore preferred for this indication. In sum, there is no place for the prophylactic use of ME and EM in obstetrics or gynaecology. They can be used for therapeutic purposes in the third stage of labour. During use, the practitioner must be alert for adverse effects.

Ergonovine↗

PubMed1997

[Ehlers-Danlos syndrome IV: phenotype variation].

In three female patients, 20, 4 and 29 years of age, Ehlers-Danlos syndrome (EDS) IV was diagnosed on the basis of a deficiency of collagen III with among other things a hyperextensible skin and joints and easy bruising. Severity of symptoms varies considerably per patient. EDS comprises 10 types. Type IV is the most severe type because of its often lethal complications like arterial rupture. Deficiency of collagen III is also seen in EDS patients without the classical severe EDS IV phenotype. It is suggested to restrict collagen III analysis to patients who are suspected of having classical EDS IV.

Adult↗

PubMed1997

Maternal consequences of caesarean section. A retrospective study of intra-operative and postoperative maternal complications of caesarean section during a 10-year period.

OBJECTIVES: This study was performed to assess the intra-operative surgical complications and postoperative maternal morbidity rate of caesarean section. STUDY DESIGN: A total of 2647 women, delivered by caesarean section in our department between 1983 and 1992, were studied retrospectively. Three caesarean section groups were formed: (1) primary elective, (2) primary acute, without any effort to deliver vaginally, and (3) secondary acute, due to a failed vaginal delivery. The Student's-t-, Fisher-exact- and chi 2-test were used for statistical analysis. RESULTS: The overall maternal intra-operative complication rate was 14.8%. The most common complications were lacerations of the uterine corpus (10.1%) and bloodloss > or = 1000 ml (7.3%). The complication rate of the secondary group (23.4%) was significantly higher (p < 0.001) compared to both primary groups (7.4%). The overall maternal postoperative morbidity rate was 35.7%. Fever (24.6%), bloodloss between 1000 and 1500 ml (4%), haematoma (3.5%) and urinary tract infections (3.0%) were the most frequent complications. The primary elective group showed significantly (p < 0.001) lower major (2.6%) and minor (23.7%) complication rates compared to the emergency groups (major 5.2%, minor 34%). CONCLUSION: Emergency caesarean sections carried the greatest risks regarding maternal complications compared to elective procedures.

Cesarean Section↗

PubMed1997

Hypermobility in two Dutch school populations.

OBJECTIVE: To determine the presence of hypermobility and differences between females and males in a Dutch population. STUDY DESIGN: Joint mobility was measured in a primary and a secondary school population. Beighton and Biro measurements were used. The data were evaluated statistically. RESULTS: Using the Beighton score, 15.5% of group I (n = 252; 4-13 years) and 13.4% of group II (n = 658; 12-17 years) were hypermobile. Hypermobility was found more in females than in males, the difference being significant in the older group. Overall, hypermobility did not significantly diminish with ageing, although the individual joints did not show a significant decrease in mobility with ageing. Hypermobility was significantly more pronounced at the non-dominant body side in both groups. The Quetelet-index did not show a significant relation to hypermobility. CONCLUSION: Hypermobility was found more in females than in males, with a trend of decrease of hypermobility with ageing. The non-dominant body side proved to be more hypermobile and the Quetelet-index did not show a relation to hypermobility. Beighton's measurements proved best, since Biro considers the two body sides being equal.

Adolescent↗

PubMed1997

The aetiology of low birthweight in a rural area of Tanzania.

In a hospital-based study, birthweights of 3162 consecutive births were related to perinatal mortality, multiple birth, and gestational age. Independent associations between 15 potential determinants and low birthweight, prematurity and small-at-term factors were also assessed. A newly constructed local curve of birthweight-for-gestational age is compared with the existing curves. The variables positively associated with low birthweight (< 2500 g) were nulliparity, vomiting as a self-reported complaint, spleen enlargement, sex of the infant and previous perinatal mortality. Nulliparity and spleen enlargement were positively associated with preterm birth, while small-at-birth was mostly associated with nulliparity and sex of the infant. Further study on spleen enlargement, the only modifiable factor in this study of possible public health importance, is warranted. Other factors of potential importance which deserve further investigations are hard physical work, maternal morbidity and antenatal care.

Female↗

PubMed1996

Survey of the management of third stage of labour in The Netherlands.

UNLABELLED: The standard practice during the third stage of labour of Dutch midwives and obstetricians was elucidated by a questionnaire mailed to all Dutch midwives and obstetricians. Prophylactic oxytocics in the third stage are used as a routine by 55% of the obstetricians and only 10% of the midwives. Oxytocin is the drug of first choice. CONCLUSION: Routine use of prophylactic oxytocics in the third stage is not the standard practice in the Netherlands. Obstetricians are much more likely to use prophylaxis than midwives.

Female↗

PubMed1996

A placebo-controlled trial of oral ergometrine to reduce postpartum hemorrhage.

BACKGROUND: Active management with oral ergometrine 0.4 mg was compared with expectant management for the control of blood loss in the third stage of labor in women at low risk of postpartum hemorrhage (PPH). METHODS: A three-arms randomized trial in which 0.4 mg ergometrine (2 tablets of 0.2 mg) was set off against placebo, both groups allowing comparison with a standard oxytocin regimen of 5 IU. Women at low risk for PPH. Of 367 parturients, 146 were randomised to ergometrine 0.4 mg, 143 to placebo and 78 to intramuscular oxytocin in a 2:2:1 design. RESULTS: Compared with placebo, ergometrine reduced blood loss with 5% (-5%; Confidence interval: -20% to +13%). Oxytocin reduced blood loss with 9% (-9%; Confidence interval: -26% to +12%) versus placebo. CONCLUSION: Oral ergometrine has too little effect on blood loss after childbirth in order to be a good alternative to parenteral prophylactic management.

Administration, Oral↗

PubMed1995

Perinatal mortality in home births in rural Tanzania.

OBJECTIVE: To compare perinatal mortality, stratified for risk level, in home births attended by a relative or traditional birth attendant without formal training with births attended by trained personnel in a dispensary or hospital. STUDY DESIGN: A prospective community based study in five villages in Northwestern Tanzania during 1990, involving 222 women delivering at home and 199 in a dispensary or hospital. RESULTS: Twenty-two of the 29 (76%) perinatal deaths occurred in home births. Perinatal mortality, stratified for risk level, was three times higher in home births than it was in births in dispensaries or in hospital (Mantel-Haenszel odds ratio, 3.29; 95% CI, 1.28-9.22). CONCLUSIONS: This study re-emphasises that all births should be attended by adequately trained personnel. More effective strategies are needed to convince women with high risk pregnancies to deliver in hospital. Emergency referral services are required to deal with unexpected complications arising in low risk births at home.

Adult↗

PubMed1995

The development of a local symphysis-fundal height chart in a rural area of Tanzania.

In this prospective community-based study, a symphysis-fundal height chart was constructed, derived from 403 measurements in 83 women, in a local rural population. Using the recommended Cardiff chart, 132 measurements (32.9%) were below the 10th centile line, while only two measurements were above the 90th centile line. This may indicate that a high percentage of the Tanzanian fetus are growth retarded or genetically small. The relative importance of each of these remains unknown. Use of the Cardiff chart in rural Tanzania could result in unnecessary referrals, which is undesirable in view of both the women involved and strained resources. Therefore, the use of a symphysis fundal height chart, based on measurements in the local population, is recommended.

Adult↗

PubMed1995

Oral administration of methylergometrine shows a late and unpredictable effect on the non-pregnant human menstruating uterus.

OBJECTIVE: To study the pharmacodynamic and pharmacokinetic properties of oral and intravenous methylergometrine upon uterine motility during menstruation. STUDY-DESIGN: Intra-uterine pressure was measured in six volunteers with a fluid-filled sponge-tipped catheter during menstruation. Methylergometrine was given orally (0.5 mg) or intravenously (0.2 mg) in a cross-over design. RESULTS: After intravenous administration, a fast increase of the frequency of uterine contractions and basal tone occurred with a decrease of amplitude, lasting at least 30 min. Oral administration had a late and less marked effect on uterine motility. An intravenous dose administered 24 h after an oral dose had no effect on uterine motility. Pharmacokinetic data, such as the maximum plasma concentration (Cmax), the time at which Cmax is reached (tmax) and the half-life of absorption (t1/2abs) also demonstrated large individual variations after oral administration. CONCLUSIONS: Oral administration of methylergometrine had an unpredictable and late effect on uterine motility on the menstruating uterus, probably due to an unpredictable bioavailability, in contrast with the fast and predictable effect after intravenous administration.

Administration, Oral↗

PubMed1995

History of ergot alkaloids from ergotism to ergometrine.

Epidemics of ergotism occurred frequently in the Middle Ages. They were a source of inspiration for artists and were popularly known as 'St. Anthony's Fire', resulting in gangrene, neurological diseases and death. It was caused by eating rye bread contaminated with the fungus claviceps purpurea. In 1582 it was described that a delivery could be hastened by administering a few spurs of the secale cornutum. The dosage was, however, very inaccurate resulting in frequent uterine ruptures. The nickname of the preparation of 'pulvis ad partum' was changed to 'pulvis ad mortem'. Therefore, after 1828 the ergot alkaloids were no longer used during delivery but only as a measure to prevent postpartum haemorrhage. From 1875 onwards many derivatives of ergot alkaloids were found. Dudley and Moir isolated ergometrine in 1932. It proved to have a very specific uterotonic action. However, because of severe and unpredictable side effects and the instability of the drug, ergometrine is not the drug of choice for either the prevention or the treatment of postpartum haemorrhage.

Ergonovine↗