Jan Nijhuis | Maastricht University Medical Center (original) (raw)
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Papers by Jan Nijhuis
Seminars in Pediatric Neurology
Electronic fetal heart rate (FHR) monitoring is widely used to assess fetal well-being throughout... more Electronic fetal heart rate (FHR) monitoring is widely used to assess fetal well-being throughout pregnancy and labor. Both antenatal and intrapartum FHR monitoring are associated with a high negative predictive value and a very poor positive predictive value. This in part reflects the physiological resilience of the healthy fetus and the remarkable effectiveness of fetal adaptations to even severe challenges. In this way, the majority of "abnormal" FHR patterns in fact reflect a fetus' appropriate adaptive responses to adverse in utero conditions. Understanding the physiology of these adaptations, how they are reflected in the FHR trace and in what conditions they can fail is therefore critical to appreciating both the potential uses and limitations of electronic FHR monitoring.
BJOG : an international journal of obstetrics and gynaecology, Dec 1, 2016
The Euro-Peristat Scientific Committee members are in Appendix 1.
BMC pregnancy and childbirth, Jan 14, 2017
The cesarean section (CS) rate has increased over recent decades with poor guideline adherence as... more The cesarean section (CS) rate has increased over recent decades with poor guideline adherence as a possible cause. The objective of this study was to explore barriers and facilitators for delivering optimal care as described in clinical practice guidelines. Key recommendations from evidence-based guidelines were used as a base to explore barriers and facilitators for delivering optimal CS care in The Netherlands. Both focus group and telephone interviews among 29 different obstetrical professionals were performed. Transcripts from the interviews were analysed. Barriers and facilitators were identified and categorised in six domains according to the framework developed by Grol: the guideline recommendations (I), the professional (II), the patient (III), the social context (IV), the organizational context (V) and the financial/legislation context (VI). Most barriers were found in the professional and organizational domain. Barriers mentioned by healthcare professionals were disagreem...
Journal of psychosomatic obstetrics and gynaecology, Jan 6, 2017
We know a great deal about how childbirth is affected by setting; we know less about how the expe... more We know a great deal about how childbirth is affected by setting; we know less about how the experience of birth is shaped by the attitudes women bring with them to the birthing room. In order to better understand how women frame childbirth, we examined the relationship between birth place preference and expectations and experiences regarding duration of labor and labor pain in healthy nulliparous women. A prospective cohort study (2007-2011) of 454 women who preferred a home birth (n = 179), a midwife-led hospital birth (n = 133) or an obstetrician-led hospital birth (n = 142) in the Netherlands. Data were collected using three questionnaires (before 20 weeks gestation, 32 weeks gestation and 6 weeks postpartum) and medical records. Analyses were performed according to the initial preferred place of birth. Women who preferred a home birth were significantly less likely to be worried about the duration of labor (OR 0.5, 95%CI 0.2-0.9) and were less likely to expect difficulties with...
Acta obstetricia et gynecologica Scandinavica, Jan 16, 2016
Large practice variation exists in mode of delivery after cesarean section, suggesting variation ... more Large practice variation exists in mode of delivery after cesarean section, suggesting variation in implementation of contemporary guidelines. We aim to evaluate this practice variation and to what extent this can be explained by risk factors at patient level. This retrospective cohort study was performed among 17 Dutch hospitals in 2010. Women with one prior cesarean section without a contraindication for a trial of labor were included. We used multivariate logistic regression analysis to develop models for risk factor adjustments. One model was derived to adjust the elective repeat cesarean section rates; a second model to adjust vaginal birth after cesarean rates. Standardized rates of elective repeat cesarean section and vaginal birth after cesarean per hospital were compared. Pseudo-R(2) measures were calculated to estimate the percentage of practice variation explained by the models. Secondary outcomes were differences in practice variation between hospital types and the corre...
American Journal of Obstetrics and Gynecology, 2016
BACKGROUND: Twin pregnancies are at increased risk for perinatal morbidity and death because of m... more BACKGROUND: Twin pregnancies are at increased risk for perinatal morbidity and death because of many factors that include a high incidence of preterm delivery. Compared with singleton pregnancies, overall perinatal risk of death is higher in twin pregnancies; however, for the preterm period, the perinatal mortality rate has been reported to be lower in twins. OBJECTIVE: The purpose of this study was to compare perinatal mortality rates in relation to gestational age at birth between singleton and twin pregnancies, taking into account socioeconomic status, fetal sex, and parity. STUDY DESIGN: We studied perinatal mortality rates according to gestational age at birth in 1,502,120 singletons pregnancies and 51,658 twin pregnancies without congenital malformations who were delivered between 2002 and 2010 after 28 weeks of gestation. Data were collected from the nationwide Netherlands Perinatal Registry. RESULTS: Overall the perinatal mortality rate in twin pregnancies (6.6/ 1000 infants) was higher than in singleton pregnancies (4.1/1000 infants). However, in the preterm period, the perinatal mortality rate in twin pregnancies was substantially lower than in singleton pregnancies (10.4 per 1000 infants as compared with 34.5 per 1000 infants, respectively) for infants who were born at <37 weeks of gestation; this held especially for antepartum deaths. After 39 weeks of gestation, the perinatal mortality rate was higher in twin pregnancies. Differences in parity, fetal sex, and socioeconomic status did not explain the observed differences in outcome. CONCLUSION: Overall the perinatal mortality rate was higher in twin pregnancies than in singleton pregnancies, which is most likely caused by the high preterm birth rate in twins and not by a higher mortality rate for gestation, apart from term pregnancies. During the preterm period, the antepartum mortality rate was much lower in twin pregnancies than in singleton pregnancies. We suggest that this might be partially due to a closer monitoring of twin pregnancies, which indirectly suggests a need for closer surveillance of singleton pregnancies.
European Journal of Obstetrics & Gynecology and Reproductive Biology, 2016
To assess the cost-effectiveness of routine labour epidural analgesia (EA), from a societal persp... more To assess the cost-effectiveness of routine labour epidural analgesia (EA), from a societal perspective, as compared with labour analgesia on request. Women delivering of a singleton in cephalic presentation beyond 36+0 weeks&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; gestation were randomly allocated to routine labour EA or analgesia on request in one university and one non-university teaching hospital in the Netherlands. Costs included all medical, non-medical and indirect costs from randomisation to 6 weeks postpartum. Effectiveness was defined as a non-operative, spontaneous vaginal delivery without EA-related maternal adverse effects. Incremental cost-effectiveness ratio (ICER) was defined as the ratio of the difference in costs and the difference in effectiveness between both groups. Data were analysed according to intention to treat and divided into a base case analysis and a sensitivity analysis. Total delivery costs in the routine EA group (n=233) were higher than in the labour on request group (n=255) (difference -€ 322, 95% CI -€ 60 to € 355) due to more medication costs (including EA), a longer stay in the labour ward, and more operations including caesarean sections. Total postpartum hospital costs in the routine EA group were lower (difference -€ 344, 95% CI -€ 1338 to € 621) mainly due to less neonatal admissions (difference -€ 472, 95% CI -€ 1297 to € 331), whereas total postpartum home and others costs were comparable (difference -€ 20, 95% CI -€ 267 to € 248, and -€ 1, 95% CI -€ 67 to € 284, respectively). As a result, the overall mean costs per woman were comparable between the routine EA group and the analgesia on request group (€ 8.708 and € 8.710, respectively, mean difference -€ 2, 95% CI -€ 1.012 to € 916). Routine labour EA resulted in more deliveries with maternal adverse effects, nevertheless the ICER remained low (€ 8; bootstrap 95% CI -€ 6.120 to € 8.659). The cost-effectiveness acceptability curve indicated a low probability that routine EA is cost-effective. Routine labour EA generates comparable costs as analgesia on request, but results in more operative deliveries and more EA-related maternal adverse effects. Based on cost-effectiveness, no preference can be given to routine labour EA as compared with analgesia on request.
Amer J Perinatol, 1993
A 30-year-old nulliparous woman underwent surgery for a ruptured aneurysm of the left vertebral a... more A 30-year-old nulliparous woman underwent surgery for a ruptured aneurysm of the left vertebral artery in gestational week 27. The fetal heart rate (FHR) was monitored continuously with an abdominal Doppler transducer. Anesthesia was induced with midazolam, fentanyl, and thiopental and maintained with fentanyl, isoflurane, and nitrous oxide 67% in oxygen. Surgery was performed under moderate hypotension (mean arterial pressure +/- 70 mmHg) and moderate hyperventilation (arterial carbon dioxide pressure +/- 33 mmHg). There was a complete disappearance of FHR variability without decelerations or bradycardia. In the night following surgery, the patient was sedated with large parenteral doses of midazolam and fentanyl. Despite this sedation, some FHR variability reappeared within 40 minutes after discontinuation of the inhalation anesthetics. After discontinuation of parenteral midazolam and fentanyl, normal FHR variability returned within 60 minutes. In week 41 of pregnancy, a healthy girl of 4015 gm was born.
J Prod Innovat Manage, 2006
The study aimed to determine if students in a redesigned course, firstly, hold different percepti... more The study aimed to determine if students in a redesigned course, firstly, hold different perceptions of the assessment demands and, secondly, adjusted their learning strategies towards deeper learning. Contrary to expectations, the students in the original assignment-based (ABL) course (n = 406 students) adopted more deeplearning strategies and less surface-learning strategies than the students in the problem-based (PBL) course 01 = 312 students). Although both course format as well as assessment clearly differed in the two conditions, this has not resulted in different perceptions of the assessment demands. Additionally, the results show clearly that the students who express their intentions to employ a certain learning strategy perceive the assessment demands as such and actually employ a related learning strategy.
Neurobiology of Aging, 2003
Amer J Obstet Gynecol, 1995
Ultrasound Med Biol, 2008
Ultrasound Obstet Gyn, 2003
Objective To detect fetal movements during non-stressed cardiotocography to evaluate the validity... more 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.
Clin Experiment Allergy, 2010
Early Hum Dev, 2001
Objectives: Fetal habituation to repeated stimulation has the potential to become a tool in the a... more 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
Ned Tijdschr Geneeskd, 1996
Nederlands Tijdschrift Voor Geneeskunde, Mar 1, 2007
Cystic abnormalities of the adnex were found by chance in 2 baby girls, one aged 2.5 months and t... more Cystic abnormalities of the adnex were found by chance in 2 baby girls, one aged 2.5 months and the other aged 2 months. Both had been born dysmaturely and the abnormalities were found on echographic investigation carried out for suspected urinary-tract infection. On monitoring investigation one month later, the abnormalities had become smaller and some time later had disappeared altogether. With the increasing use of ultrasound, ovarian cysts are being detected more often in the foetus and neonate. The majority of these cysts are benign functional follicular cysts and resolve spontaneously. The decision to perform surgery depends on the clinical symptoms and appearance on ultrasound. Large uncomplicated cysts can be managed by antenatal or postnatal aspiration in order to prevent torsion and the subsequent loss of the adnex.
Early Hum Dev, 1994
The development of fetal behaviour and of fetal behavioural states (FBS) has been well defined in... more The development of fetal behaviour and of fetal behavioural states (FBS) has been well defined in preterm and term fetuses. However, FBS have not yet been studied after term, although this is a potentially very dangerous period and clinical management is controversial. We investigated fetal behaviour in normal pregnancies after 41 weeks of gestation (287 days, menstrual age, GA) as compared to control term fetuses. Furthermore, we wanted to see if the findings might have consequences for clinical management. Twelve healthy women with GA between 289 and 298 days participated. All pregnancies were reliably dated and at the time of the study, there was a normal amount of fluid. Twelve healthy women with GA 273-287 days served as controls. All subjects underwent a behavioural study using cardiotocography to record the heart rate (CTG), and two ultrasound scanners to observe body and eye movements, as described previously. All fetuses in both groups clearly exhibited FBS lF-4F which fitted the definitions of Nijhuis et al. [5]. The median percentage of FBS 3F and 4F ('awake states') increased significantly from 6% in the term group to 21.5% in the fetuses after 41 weeks (P = 0.014). FBS 1F ('quiet sleep') and 2F ('active sleep') decreased from 92 to 78% (P = 0.014), mainly at the expense of FBS 2F which decreased from 78 to 58% (P= 0.002). This indicates increasing wakefulness in utero. The fetal heart rate patterns (FHRP) associated with FBS 3F and 4F were impressive. For example, in FBS 4F, the FHRP showed large amplitude, prolonged accelerations which fused into a sustained tachycardia with only short periods of return to the baseline, resembling tachycardia with decelerations. We conclude that in normal pregnancies after 41 weeks, the development of the fetal central nervous system continues, resulting in an increasing percentage of 'fetal wakefulness'. The CTG-patterns that result from these behaviours can easily mimic fetal distress and one should be aware of this phenomenon. Whether behavioural studies can be used to distinguish 'normal' from 'abnormal' fetuses after term awaits further study.
Eur J Obstet Gyn Reprod Biol, 1994
Seminars in Pediatric Neurology
Electronic fetal heart rate (FHR) monitoring is widely used to assess fetal well-being throughout... more Electronic fetal heart rate (FHR) monitoring is widely used to assess fetal well-being throughout pregnancy and labor. Both antenatal and intrapartum FHR monitoring are associated with a high negative predictive value and a very poor positive predictive value. This in part reflects the physiological resilience of the healthy fetus and the remarkable effectiveness of fetal adaptations to even severe challenges. In this way, the majority of &amp;quot;abnormal&amp;quot; FHR patterns in fact reflect a fetus&amp;#39; appropriate adaptive responses to adverse in utero conditions. Understanding the physiology of these adaptations, how they are reflected in the FHR trace and in what conditions they can fail is therefore critical to appreciating both the potential uses and limitations of electronic FHR monitoring.
BJOG : an international journal of obstetrics and gynaecology, Dec 1, 2016
The Euro-Peristat Scientific Committee members are in Appendix 1.
BMC pregnancy and childbirth, Jan 14, 2017
The cesarean section (CS) rate has increased over recent decades with poor guideline adherence as... more The cesarean section (CS) rate has increased over recent decades with poor guideline adherence as a possible cause. The objective of this study was to explore barriers and facilitators for delivering optimal care as described in clinical practice guidelines. Key recommendations from evidence-based guidelines were used as a base to explore barriers and facilitators for delivering optimal CS care in The Netherlands. Both focus group and telephone interviews among 29 different obstetrical professionals were performed. Transcripts from the interviews were analysed. Barriers and facilitators were identified and categorised in six domains according to the framework developed by Grol: the guideline recommendations (I), the professional (II), the patient (III), the social context (IV), the organizational context (V) and the financial/legislation context (VI). Most barriers were found in the professional and organizational domain. Barriers mentioned by healthcare professionals were disagreem...
Journal of psychosomatic obstetrics and gynaecology, Jan 6, 2017
We know a great deal about how childbirth is affected by setting; we know less about how the expe... more We know a great deal about how childbirth is affected by setting; we know less about how the experience of birth is shaped by the attitudes women bring with them to the birthing room. In order to better understand how women frame childbirth, we examined the relationship between birth place preference and expectations and experiences regarding duration of labor and labor pain in healthy nulliparous women. A prospective cohort study (2007-2011) of 454 women who preferred a home birth (n = 179), a midwife-led hospital birth (n = 133) or an obstetrician-led hospital birth (n = 142) in the Netherlands. Data were collected using three questionnaires (before 20 weeks gestation, 32 weeks gestation and 6 weeks postpartum) and medical records. Analyses were performed according to the initial preferred place of birth. Women who preferred a home birth were significantly less likely to be worried about the duration of labor (OR 0.5, 95%CI 0.2-0.9) and were less likely to expect difficulties with...
Acta obstetricia et gynecologica Scandinavica, Jan 16, 2016
Large practice variation exists in mode of delivery after cesarean section, suggesting variation ... more Large practice variation exists in mode of delivery after cesarean section, suggesting variation in implementation of contemporary guidelines. We aim to evaluate this practice variation and to what extent this can be explained by risk factors at patient level. This retrospective cohort study was performed among 17 Dutch hospitals in 2010. Women with one prior cesarean section without a contraindication for a trial of labor were included. We used multivariate logistic regression analysis to develop models for risk factor adjustments. One model was derived to adjust the elective repeat cesarean section rates; a second model to adjust vaginal birth after cesarean rates. Standardized rates of elective repeat cesarean section and vaginal birth after cesarean per hospital were compared. Pseudo-R(2) measures were calculated to estimate the percentage of practice variation explained by the models. Secondary outcomes were differences in practice variation between hospital types and the corre...
American Journal of Obstetrics and Gynecology, 2016
BACKGROUND: Twin pregnancies are at increased risk for perinatal morbidity and death because of m... more BACKGROUND: Twin pregnancies are at increased risk for perinatal morbidity and death because of many factors that include a high incidence of preterm delivery. Compared with singleton pregnancies, overall perinatal risk of death is higher in twin pregnancies; however, for the preterm period, the perinatal mortality rate has been reported to be lower in twins. OBJECTIVE: The purpose of this study was to compare perinatal mortality rates in relation to gestational age at birth between singleton and twin pregnancies, taking into account socioeconomic status, fetal sex, and parity. STUDY DESIGN: We studied perinatal mortality rates according to gestational age at birth in 1,502,120 singletons pregnancies and 51,658 twin pregnancies without congenital malformations who were delivered between 2002 and 2010 after 28 weeks of gestation. Data were collected from the nationwide Netherlands Perinatal Registry. RESULTS: Overall the perinatal mortality rate in twin pregnancies (6.6/ 1000 infants) was higher than in singleton pregnancies (4.1/1000 infants). However, in the preterm period, the perinatal mortality rate in twin pregnancies was substantially lower than in singleton pregnancies (10.4 per 1000 infants as compared with 34.5 per 1000 infants, respectively) for infants who were born at <37 weeks of gestation; this held especially for antepartum deaths. After 39 weeks of gestation, the perinatal mortality rate was higher in twin pregnancies. Differences in parity, fetal sex, and socioeconomic status did not explain the observed differences in outcome. CONCLUSION: Overall the perinatal mortality rate was higher in twin pregnancies than in singleton pregnancies, which is most likely caused by the high preterm birth rate in twins and not by a higher mortality rate for gestation, apart from term pregnancies. During the preterm period, the antepartum mortality rate was much lower in twin pregnancies than in singleton pregnancies. We suggest that this might be partially due to a closer monitoring of twin pregnancies, which indirectly suggests a need for closer surveillance of singleton pregnancies.
European Journal of Obstetrics & Gynecology and Reproductive Biology, 2016
To assess the cost-effectiveness of routine labour epidural analgesia (EA), from a societal persp... more To assess the cost-effectiveness of routine labour epidural analgesia (EA), from a societal perspective, as compared with labour analgesia on request. Women delivering of a singleton in cephalic presentation beyond 36+0 weeks&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; gestation were randomly allocated to routine labour EA or analgesia on request in one university and one non-university teaching hospital in the Netherlands. Costs included all medical, non-medical and indirect costs from randomisation to 6 weeks postpartum. Effectiveness was defined as a non-operative, spontaneous vaginal delivery without EA-related maternal adverse effects. Incremental cost-effectiveness ratio (ICER) was defined as the ratio of the difference in costs and the difference in effectiveness between both groups. Data were analysed according to intention to treat and divided into a base case analysis and a sensitivity analysis. Total delivery costs in the routine EA group (n=233) were higher than in the labour on request group (n=255) (difference -€ 322, 95% CI -€ 60 to € 355) due to more medication costs (including EA), a longer stay in the labour ward, and more operations including caesarean sections. Total postpartum hospital costs in the routine EA group were lower (difference -€ 344, 95% CI -€ 1338 to € 621) mainly due to less neonatal admissions (difference -€ 472, 95% CI -€ 1297 to € 331), whereas total postpartum home and others costs were comparable (difference -€ 20, 95% CI -€ 267 to € 248, and -€ 1, 95% CI -€ 67 to € 284, respectively). As a result, the overall mean costs per woman were comparable between the routine EA group and the analgesia on request group (€ 8.708 and € 8.710, respectively, mean difference -€ 2, 95% CI -€ 1.012 to € 916). Routine labour EA resulted in more deliveries with maternal adverse effects, nevertheless the ICER remained low (€ 8; bootstrap 95% CI -€ 6.120 to € 8.659). The cost-effectiveness acceptability curve indicated a low probability that routine EA is cost-effective. Routine labour EA generates comparable costs as analgesia on request, but results in more operative deliveries and more EA-related maternal adverse effects. Based on cost-effectiveness, no preference can be given to routine labour EA as compared with analgesia on request.
Amer J Perinatol, 1993
A 30-year-old nulliparous woman underwent surgery for a ruptured aneurysm of the left vertebral a... more A 30-year-old nulliparous woman underwent surgery for a ruptured aneurysm of the left vertebral artery in gestational week 27. The fetal heart rate (FHR) was monitored continuously with an abdominal Doppler transducer. Anesthesia was induced with midazolam, fentanyl, and thiopental and maintained with fentanyl, isoflurane, and nitrous oxide 67% in oxygen. Surgery was performed under moderate hypotension (mean arterial pressure +/- 70 mmHg) and moderate hyperventilation (arterial carbon dioxide pressure +/- 33 mmHg). There was a complete disappearance of FHR variability without decelerations or bradycardia. In the night following surgery, the patient was sedated with large parenteral doses of midazolam and fentanyl. Despite this sedation, some FHR variability reappeared within 40 minutes after discontinuation of the inhalation anesthetics. After discontinuation of parenteral midazolam and fentanyl, normal FHR variability returned within 60 minutes. In week 41 of pregnancy, a healthy girl of 4015 gm was born.
J Prod Innovat Manage, 2006
The study aimed to determine if students in a redesigned course, firstly, hold different percepti... more The study aimed to determine if students in a redesigned course, firstly, hold different perceptions of the assessment demands and, secondly, adjusted their learning strategies towards deeper learning. Contrary to expectations, the students in the original assignment-based (ABL) course (n = 406 students) adopted more deeplearning strategies and less surface-learning strategies than the students in the problem-based (PBL) course 01 = 312 students). Although both course format as well as assessment clearly differed in the two conditions, this has not resulted in different perceptions of the assessment demands. Additionally, the results show clearly that the students who express their intentions to employ a certain learning strategy perceive the assessment demands as such and actually employ a related learning strategy.
Neurobiology of Aging, 2003
Amer J Obstet Gynecol, 1995
Ultrasound Med Biol, 2008
Ultrasound Obstet Gyn, 2003
Objective To detect fetal movements during non-stressed cardiotocography to evaluate the validity... more 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.
Clin Experiment Allergy, 2010
Early Hum Dev, 2001
Objectives: Fetal habituation to repeated stimulation has the potential to become a tool in the a... more 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
Ned Tijdschr Geneeskd, 1996
Nederlands Tijdschrift Voor Geneeskunde, Mar 1, 2007
Cystic abnormalities of the adnex were found by chance in 2 baby girls, one aged 2.5 months and t... more Cystic abnormalities of the adnex were found by chance in 2 baby girls, one aged 2.5 months and the other aged 2 months. Both had been born dysmaturely and the abnormalities were found on echographic investigation carried out for suspected urinary-tract infection. On monitoring investigation one month later, the abnormalities had become smaller and some time later had disappeared altogether. With the increasing use of ultrasound, ovarian cysts are being detected more often in the foetus and neonate. The majority of these cysts are benign functional follicular cysts and resolve spontaneously. The decision to perform surgery depends on the clinical symptoms and appearance on ultrasound. Large uncomplicated cysts can be managed by antenatal or postnatal aspiration in order to prevent torsion and the subsequent loss of the adnex.
Early Hum Dev, 1994
The development of fetal behaviour and of fetal behavioural states (FBS) has been well defined in... more The development of fetal behaviour and of fetal behavioural states (FBS) has been well defined in preterm and term fetuses. However, FBS have not yet been studied after term, although this is a potentially very dangerous period and clinical management is controversial. We investigated fetal behaviour in normal pregnancies after 41 weeks of gestation (287 days, menstrual age, GA) as compared to control term fetuses. Furthermore, we wanted to see if the findings might have consequences for clinical management. Twelve healthy women with GA between 289 and 298 days participated. All pregnancies were reliably dated and at the time of the study, there was a normal amount of fluid. Twelve healthy women with GA 273-287 days served as controls. All subjects underwent a behavioural study using cardiotocography to record the heart rate (CTG), and two ultrasound scanners to observe body and eye movements, as described previously. All fetuses in both groups clearly exhibited FBS lF-4F which fitted the definitions of Nijhuis et al. [5]. The median percentage of FBS 3F and 4F ('awake states') increased significantly from 6% in the term group to 21.5% in the fetuses after 41 weeks (P = 0.014). FBS 1F ('quiet sleep') and 2F ('active sleep') decreased from 92 to 78% (P = 0.014), mainly at the expense of FBS 2F which decreased from 78 to 58% (P= 0.002). This indicates increasing wakefulness in utero. The fetal heart rate patterns (FHRP) associated with FBS 3F and 4F were impressive. For example, in FBS 4F, the FHRP showed large amplitude, prolonged accelerations which fused into a sustained tachycardia with only short periods of return to the baseline, resembling tachycardia with decelerations. We conclude that in normal pregnancies after 41 weeks, the development of the fetal central nervous system continues, resulting in an increasing percentage of 'fetal wakefulness'. The CTG-patterns that result from these behaviours can easily mimic fetal distress and one should be aware of this phenomenon. Whether behavioural studies can be used to distinguish 'normal' from 'abnormal' fetuses after term awaits further study.
Eur J Obstet Gyn Reprod Biol, 1994
Health Council of the Netherlands, May 2020
In accordance with Dutch law, a body of a deceased person can be buried, cremated or donated to s... more In accordance with Dutch law, a body of a deceased person can be buried, cremated or donated to science. New techniques are being developed, like alkaline hydrolysis and composting. At the request of the Ministry of the Interior and Kingdom Relations, the Health Council of the Netherlands proposed a framework that can be utilised to assess the admissibility of such new techniques. Three values should be taken as guidelines: safety, dignity and sustainability. Alkaline hydrolysis fulfills the conditions, according to the Council. Too little is known about composting and hence it cannot be assessed whether this technique fulfills the conditions.