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1.
Neth J Med ; 74(1): 22-9, 2016 Jan.
Article in English | MEDLINE | ID: mdl-26819358

ABSTRACT

BACKGROUND: The influence of ethnicity in women with gestational diabetes in relation to maternal, pregnancy and neonatal outcome is not well defined. AIM: To compare the perinatal outcome in women with gestational diabetes between different ethnic groups reflecting the multi-ethnic population in the Netherlands. METHODS: Patients with gestational diabetes (n = 388) who visited the multidisciplinary outpatient clinic for Diabetes Care and Obstetrics of the Sint Franciscus Gasthuis in Rotterdam between 2010 and 2013 were included. Ethnicity was distinguished into six groups: Moroccan (n = 100); Turkish (n = 43); Caucasian (n = 146); Suriname-Creole (n = 23); Suriname-Hindu (n = 32); and Miscellaneous (n = 44). RESULTS: Caucasians were the largest group with gestational diabetes (37.7%), followed by Moroccans (25.8%). Body mass index before pregnancy was highest in Surinamese-Creole women, followed by Turks and Moroccans (p < 0.001). Gravidity and parity were highest in Moroccans. Gravidity was lowest in Surinamese-Hindus and parity was lowest in Caucasians (p < 0.001). There was also a remarkable, significant difference in the mode of delivery between the ethnicities with the lowest number of normal deliveries in Caucasians and the highest in Moroccans (p = 0.03). Assisted delivery occurred most frequently in Caucasian women, although there was no difference in the frequency of caesarean sections. Birth weight was the only neonatal parameter showing significant differences between the ethnicities, with the highest birth weight for Moroccan children and the lowest for Surinamese children (3542 g vs. 3200; p = 0.001). CONCLUSION: This study did not show major differences in maternal or neonatal complications, however there are significant disparities in (percentile) birth weight and mode of delivery across the different ethnic groups.


Subject(s)
Diabetes, Gestational/ethnology , Ethnicity/statistics & numerical data , Pregnancy Outcome/ethnology , Adult , Birth Weight , Body Mass Index , Delivery, Obstetric/methods , Female , Gravidity , Hinduism , Humans , Infant, Newborn , Morocco/ethnology , Netherlands/epidemiology , Parity , Pregnancy , Suriname/ethnology , Turkey/ethnology , White People/statistics & numerical data
3.
Eur J Obstet Gynecol Reprod Biol ; 80(1): 39-44, 1998 Sep.
Article in English | MEDLINE | ID: mdl-9758257

ABSTRACT

OBJECTIVE: To study plasma concentrations of endothelin (ET), lipidhydroperoxides (LOOH), glutathione peroxidase (GSHpx) and fibronectin in relation to abnormal umbilical artery velocimetry. STUDY DESIGN: Plasma concentrations of ET, LOOH, GSHpx and fibronectin were measured in fetal and maternal venous blood in: (i) a control group (n=10); (ii) in pregnancies complicated by intrauterine growth retardation (IUGR) (n=6) or preeclampsia (n=5) with positive end diastolic flow; and in (iii) pregnancies complicated by absent or reversed end diastolic (ARED) flow in the umbilical artery (n=18). All children were delivered by primary caesarean section. RESULTS: The significantly highest maternal and fetal ET concentrations were found in plasma collected in pregnancies complicated by ARED flow in the umbilical artery. Maternal fibronectin levels were significantly raised in the ARED flow group. Maternal plasma ET levels were lowest in pregnancies complicated by IUGR. The maternal and fetal plasma concentrations of LOOH and GSHpx did not differ significantly between the groups. CONCLUSION: Abnormal Doppler velocimetry, especially ARED flow is associated with elevated maternal and fetal plasma levels of ET. The exact mechanism causing the placental vasoconstriction is unknown yet, but oxidative stress seems not to be involved.


Subject(s)
Endothelins/blood , Fibronectins/blood , Glutathione Peroxidase/blood , Lipid Peroxides/blood , Pregnancy Complications/physiopathology , Umbilical Arteries/physiopathology , Female , Fetal Blood/metabolism , Fetal Growth Retardation/physiopathology , Humans , Laser-Doppler Flowmetry , Pre-Eclampsia/physiopathology , Pregnancy
4.
Placenta ; 17(7): 393-9, 1996 Sep.
Article in English | MEDLINE | ID: mdl-8899867

ABSTRACT

The aim of the study was to investigate if a relation exists between absent or reversed end diastolic (ARED) flow in the umbilical artery and morphometric characteristics of the placenta. Geometric parameters were measured in the terminal villi of nine placentae, collected after a pregnancy complicated by ARED flow. Placentae from pregnancies with normal Doppler velocimetry in the umbilical artery were matched for gestational age and formed the control group. Mean placental weight in the ARED group was significantly lower than in the control group. Morphometric characteristics of the terminal placental villi did not differ substantially between the two groups before 30 weeks gestation. After 30 weeks mean villous profile cross sectional area and diameter were significantly smaller in the ARED group than in the control group. The mean profile cross sectional villous diameter in the ARED group did not differ substantially before and after 30 weeks of gestation (2287 microns2 and 2303 microns2, respectively). Accelerated maturation of terminal villi occurs in placentae delivered after a pregnancy with ARED flow in the umbilical artery. Morphometric characteristics are significantly different between placentae expelled after ARED velocities or after normal Doppler recordings in the umbilical artery. In ARED placentae, a significantly more uniform pattern of small villi is found compared with control placentae.


Subject(s)
Diastole , Placenta/pathology , Pregnancy Complications, Cardiovascular/pathology , Pregnancy Complications, Cardiovascular/physiopathology , Umbilical Arteries/physiopathology , Blood Flow Velocity , Female , Gestational Age , Humans , Organ Size , Pregnancy , Ultrasonography , Umbilical Arteries/diagnostic imaging
5.
Lancet ; 344(8938): 1664-8, 1994 Dec 17.
Article in English | MEDLINE | ID: mdl-7996959

ABSTRACT

Doppler ultrasound provides a non invasive method to assess fetal haemodynamics. We looked at the outcome of doppler velocimetry of the umbilical artery in three groups of pregnancies: those with positive end diastolic velocities (PED; n = 214), absent end diastolic velocities (AED; n = 178) and reversed end diastolic velocities (RED; n = 67). We collected our data from 9 European centers. Logistic regression showed that compared with pregnancies with hypertension only, pregnancies complicated by intra uterine growth retardation (IUGR) had a higher risk of developing absent or reversed end diastolic velocity waveforms (ARED) flow. ARED flow in the umbilical artery (odds ratio: OR = 3.1). Pregnancies complicated by both IUGR and hypertension had an even higher risk (OR = 7.4). Maternal age and smoking habits did not influence the risk of developing ARED flow. The overall perinatal mortality rate was 28%. Significantly more neonates in the ARED flow group needed admittance to the neonatal intensive care unit (PED group 60%, AED group 96%, RED group 98%). The OR for perinatal mortality in pregnancies complicated by AED flow was 4.0 and in RED flow was 10.6, compared with PED flow, even after adjustment for menstrual age. ARED flow in the umbilical artery did not influence the risk of respiratory distress syndrome or necrotising enterocolitis of the neonate, but ARED flow significantly influenced the risk of cerebral haemorrhage, anaemia, or hypoglycaemia. We advise that pregnancies complicated by IUGR and/or hypertension should be followed up with doppler velocimetry to trace utero-placental problems as early as possible. A caesarean section is recommended in all pregnancies complicated by ARED flow if the gestational age and predicted neonatal weight can be handled by the local neonatal intensive care unit.


Subject(s)
Fetal Growth Retardation/diagnosis , Laser-Doppler Flowmetry , Pregnancy Complications, Cardiovascular/diagnosis , Umbilical Arteries , Adult , Female , Fetal Death , Gestational Age , Hemodynamics , Humans , Hypertension/diagnosis , Male , Maternal Age , Pregnancy , Prospective Studies , Risk Factors
6.
Eur J Obstet Gynecol Reprod Biol ; 57(2): 117-22, 1994 Nov.
Article in English | MEDLINE | ID: mdl-7859903

ABSTRACT

OBJECTIVE: To study possible relationships between abnormal placental perfusion, hypoxemia and impaired fetal nutrient supply. STUDY DESIGN: Umbilical artery flow velocity waveforms were assessed in high risk pregnancies and compared with controls. Three groups were studied. In group I (n = 13) the pulsatility index (PI) was within normal limits, in group II (n = 9) PI was > 2 S.D. in the presence of positive end diastolic velocities and in group III (n = 13) end diastolic velocities were absent. pH and PO2 levels and concentrations of amino acids, glucose and lactate were measured in umbilical blood obtained at cesarean section (n = 35). RESULTS: An inverse correlation was found between concentrations of essential amino acids concentrations and the pulsatility index in the umbilical artery (P = 0.03). No correlation with hypoxemia was found (P = 0.32). The glycine/valine ratio was significantly increased in the groups with abnormal Doppler velocity indices (P = 0.02). Glucose concentrations were significantly reduced in the case of absent end diastolic velocities (P = 0.001). No significant differences were found between the three groups concerning lactate concentrations and acid-base balance parameters. CONCLUSIONS: These findings, especially the increased glycine/valine ratio, which is characteristic for kwashiorkor, indicate that abnormal placental perfusion is associated with impaired fetal nutrient supply, in the presence of a normal fetal oxygenation.


Subject(s)
Amino Acids/blood , Blood Glucose/metabolism , Fetal Blood/metabolism , Lactates/blood , Umbilical Arteries/physiology , Acid-Base Equilibrium , Blood Flow Velocity , Female , Glycine/blood , Humans , Hydrogen-Ion Concentration , Lactic Acid , Oxygen/blood , Pregnancy , Regression Analysis , Valine/blood
7.
Hum Reprod ; 9(8): 1576-9, 1994 Aug.
Article in English | MEDLINE | ID: mdl-7989525

ABSTRACT

Until now, the traditional management of interstitial pregnancy has been surgical. Lately, we have advocated conservative treatment with methotrexate as an option for infertility patients. This is the first publication of a rupture with abundant intra-abdominal bleeding during systemic treatment with methotrexate of a patient with an interstitial pregnancy. Signs of therapy failure are discussed.


Subject(s)
Methotrexate/therapeutic use , Pregnancy, Ectopic/drug therapy , Adult , Chorionic Gonadotropin/blood , Female , Hemorrhage , Humans , Methotrexate/administration & dosage , Pregnancy , Pregnancy, Ectopic/diagnostic imaging , Pregnancy, Ectopic/surgery , Rupture, Spontaneous , Ultrasonography
8.
Obstet Gynecol ; 80(4): 679-83, 1992 Oct.
Article in English | MEDLINE | ID: mdl-1407894

ABSTRACT

OBJECTIVE: To determine the effects of maternal volume expansion on feto- and uteroplacental blood flow and neonatal outcome. METHODS: Seven women with pregnancies characterized by absent end-diastolic velocity in the umbilical artery were treated with bed rest, antihypertensive medication, and volume expansion (expanded group) and compared with seven similar cases treated with bed rest and antihypertensive medication (unexpanded group). RESULTS: In the expanded group, end-diastolic flow reappeared temporarily in all cases after volume expansion. The pulsatility index in the umbilical artery decreased from 2.69 (95% confidence interval [CI] 2.1-3.2) to 2.15 (95% CI 1.74-2.56) 24 hours after maternal volume expansion (P less than .001). All cases in the unexpanded group continued to demonstrate absent end-diastolic velocity. There was no significant difference between the groups with regard to birth weight, which was 773 g (95% CI 521-1025) in the expanded group and 724 g (95% CI 429-1019) in the unexpanded group (P = .76). The gestational age at delivery was not significantly different between the groups: 203 days in the expanded group (95% CI 195-211) and 207 days in the unexpanded group (95% CI 189-225) (P = .71). The overall survival rate was significantly better in the expanded group: five of seven, versus one of seven in the unexpanded group (P less than .05). CONCLUSIONS: These preliminary data suggest that it is possible to improve feto- and uteroplacental perfusion with maternal volume expansion. The results point toward an improvement in neonatal outcome. Randomized trials are necessary to confirm our observations.


Subject(s)
Fetal Growth Retardation/therapy , Hemodilution , Hypertension/therapy , Pregnancy Complications, Cardiovascular/therapy , Pregnancy Outcome , Umbilical Arteries/physiopathology , Antihypertensive Agents/therapeutic use , Bed Rest , Blood Flow Velocity , Diastole/physiology , Female , Fetal Growth Retardation/physiopathology , Humans , Hypertension/drug therapy , Hypertension/physiopathology , Pilot Projects , Placenta/blood supply , Pregnancy , Pregnancy Complications, Cardiovascular/drug therapy , Pregnancy Complications, Cardiovascular/physiopathology
9.
Hum Reprod ; 7(8): 1164-9, 1992 Sep.
Article in English | MEDLINE | ID: mdl-1400944

ABSTRACT

Five patients with vital, unruptured interstitial pregnancies of less than 3 cm maximum diameter were treated successfully with methotrexate and leucovorin rescue. Four pregnancies showed cardiac activity. Diagnosis was established with transvaginal ultrasonography in all patients. The human chorionic gonadotrophin serum levels were measured to monitor the effectiveness of therapy. This is the first publication on methotrexate treatment for interstitial twin pregnancy and the first on instillation of methotrexate after puncture and aspiration of interstitial pregnancy. In all cases, total and uneventful regression of trophoblast tissue was achieved. No adverse reactions were observed. The advantages and drawbacks of these therapeutic approaches are discussed. Methotrexate appears to be an effective medical non-surgical treatment for unruptured interstitial pregnancy with or without cardiac activity, and preserves reproductive potential.


Subject(s)
Methotrexate/therapeutic use , Pregnancy, Tubal/drug therapy , Adult , Chorionic Gonadotropin/blood , Female , Humans , Leucovorin/therapeutic use , Pregnancy , Pregnancy, Multiple , Pregnancy, Tubal/diagnostic imaging , Ultrasonography
10.
Eur J Obstet Gynecol Reprod Biol ; 42 Suppl: S79-83, 1991 Dec.
Article in English | MEDLINE | ID: mdl-1839731

ABSTRACT

Intra-uterine growth retardation (IUGR) is an important cause of perinatal death. The maternal chain seems to influence the birth weight and IUGR is also significantly associated with the presence of congenital malformation. To evaluate this association, a study was performed in all cases of IUGR collected over a period of 10 years. In 21.8% of the IUGR fetuses, one or more congenital malformations were found by level 3 ultrasound examination. The main defects were chromosomal anomalies and disorders of the renal- and central nervous tract. The advice is given to offer all pregnant women, not only those at risk for birth defects, an ultrasound examination at 16 to 18 weeks of pregnancy to optimize the approach to delivery and to decrease the number of perinatal mortalities.


Subject(s)
Fetal Growth Retardation/pathology , Abdominal Muscles/abnormalities , Central Nervous System/abnormalities , Chromosome Aberrations , Congenital Abnormalities/diagnostic imaging , Fetal Growth Retardation/diagnostic imaging , Fetal Growth Retardation/genetics , Humans , Kidney/abnormalities , Ultrasonography
11.
Prenat Diagn ; 11(8): 655-60, 1991 Aug.
Article in English | MEDLINE | ID: mdl-1837358

ABSTRACT

Over a 6 1/2 year period, in 288 pregnancies a variety of fetal malformations were detected by ultrasound. Two hundred and ten fetuses (73 per cent) were karyotyped. Gestational age at detection ranged from 11 to 38 weeks. The incidence of an abnormal karyotype in the total series was 14 per cent and 14.7 per cent in the 210 pregnancies in which a karyotype was performed. Single structural anomalies were found in 149 cytogenetically investigated fetuses, of which 25 had a chromosomal abnormality (17 per cent). Multiple structural malformations were present in 61 fetuses, of which 16 had an abnormal karyotype (26 per cent). Trisomy 18 was the most frequent finding. The most constant ultrasound finding in cases of an abnormal karyotype was polyhydramnios and severe IUGR in combination with structural defects. There is a need for extensive detailed ultrasound examination in high-risk pregnancies.


Subject(s)
Congenital Abnormalities/diagnosis , Ultrasonography, Prenatal , Chromosomes, Human, Pair 13 , Chromosomes, Human, Pair 18 , Congenital Abnormalities/epidemiology , Congenital Abnormalities/genetics , Down Syndrome/diagnosis , Female , Fetal Growth Retardation/diagnosis , Humans , Karyotyping , Pregnancy , Trisomy
12.
Eur J Obstet Gynecol Reprod Biol ; 39(2): 157-61, 1991 Apr 16.
Article in English | MEDLINE | ID: mdl-2050257

ABSTRACT

A case of prenatal diagnosed thoracopagus conjoined twins is presented. In thoracopagus twins the cardiovascular system mainly determines the options for separation and survival. Therefore prenatal investigation of this organ system is indispensable. Ultrasound level-2 examination predicted the impossibility of separation and fully matched the autopsy findings. In conclusion, ultrasound examination appears to be an important tool to enable planning of the optimal delivery approach.


Subject(s)
Pregnancy, Multiple , Twins, Conjoined , Ultrasonography, Prenatal , Adult , Female , Heart Defects, Congenital , Humans , Liver/abnormalities , Pregnancy , Twins, Conjoined/pathology
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