Objective To quantify the association between prophylactic radiologic interventions and perioperative blood loss in women with risk factors for placenta accreta spectrum disorder (PAS)Methods We... Show moreObjective To quantify the association between prophylactic radiologic interventions and perioperative blood loss in women with risk factors for placenta accreta spectrum disorder (PAS)Methods We conducted a retrospective nationwide cohort study of women with risk factors for placenta accreta spectrum disorder who underwent planned cesarean section in 69 Dutch hospitals between 2008 and 2013. All women had two risk factors for PAS: placenta previa/anterior low-lying placenta and a history of cesarean section(s). Women with and without ultrasonographic signs of PAS were studied as two separate groups. We compared the total blood loss of women with prophylactic radiologic interventions, defined as preoperative placement of balloon catheters or sheaths in the internal iliac or uterine arteries, with that of a control group consisting of women without prophylactic radiologic interventions using multivariable regression. We evaluated maternal morbidity by the number of red blood cell (RBC) units transfused within 24 h following childbirth (categories: 0, 1-3, >4), duration of hospital admission, and need for intensive care unit (ICU) admission.Results A total of 350 women with placenta previa/anterior low-lying placenta and history of cesarean section(s) were included: 289 with normal ultrasonography, of whom 21 received prophylactic radiologic intervention, and 61 had abnormal ultrasonography, of whom 22 received prophylactic intervention. Among women with normal ultrasonography without prophylactic intervention (n = 268), the median blood loss was 725 mL (interquartile range (IQR) 500-1500) vs. 1000 mL (IQR 550-1750) in women with intervention (n = 21); the adjusted difference in blood loss was 9 mL (95% confidence interval (CI) -315-513), p = .97). Among women with abnormal ultrasonography, those without prophylactic intervention (n = 39) had a median blood loss of 2500 mL (IQR 1200-5000) vs. 1750 mL (IQR 775-4000) in women with intervention (n = 22); the adjusted difference in blood loss was -1141 mL (95% CI -1694- -219, p = .02). Results of outcomes on maternal morbidity were comparable among women with and without prophylactic intervention.Conclusion These findings suggest that prophylactic radiologic interventions prior to planned cesarean section may help to limit perioperative blood loss in women with clear signs of placenta accreta spectrum disorder on ultrasonography, but there was no evidence of a difference within the subgroup without such ultrasonographic signs. The use of these interventions should be discussed in a multidisciplinary shared decision-making process, including discussions of potential benefits and possible complications.Trial registration Netherlands Trial Registry, https://onderzoekmetmensen.nl/en/trial/28238, identifier NL4210 (NTR4363) Show less
Therapeutic hypothermia in neonates with perinatal asphyxia may increase the risk of PPHN. This potentially affects outcome.Objectives(1) To investigate whether neonates with perinatal asphyxia and... Show moreTherapeutic hypothermia in neonates with perinatal asphyxia may increase the risk of PPHN. This potentially affects outcome.Objectives(1) To investigate whether neonates with perinatal asphyxia and therapeutic hypothermia more often developed PPHN compared to a control group with perinatal asphyxia not treated with hypothermia; (2) To identify risk factors for severe PPHN during hypothermia and evaluate short-term outcome.MethodsThis single-center retrospective cohort study included (near-)term neonates with perinatal asphyxia admitted between 2004 and 2016. Neonates with perinatal asphyxia and hypothermia were compared to a historical control group without hypothermia. Primary outcome was PPHN, defined as severe hypoxemia requiring mechanical ventilation and inhaled nitric oxide, confirmed by echocardiography. Short-term adverse outcome was defined as mortality within one month and/or severe brain injury on MRI.ResultsIncidence of PPHN was 23% (26/114) in the hypothermia group and 11% (8/70) in controls. In multivariate analysis, PPHN was 2.5 times more common among neonates with hypothermia. Neonates developing PPHN during hypothermia often had higher fraction of inspired oxygen at baseline. PPHN was not associated with a higher risk of severe brain injury. However, early mortality was higher and three infants died due to severe refractory PPHN during hypothermia.ConclusionsIn this study PPHN occurred more often since the introduction of therapeutic hypothermia. This was usually reversible and did not lead to overall increased adverse outcome. However, in individual cases with PPHN deterioration occurred rapidly. In such cases the benefits of hypothermia should be weighed against the risk of a complicated, fatal course. Show less
Objective: To describe the effect of umbilical catheterization (UC) on skin temperature and cardiorespiratory status in preterm infants.Materials and methods: In a prospective observational study... Show moreObjective: To describe the effect of umbilical catheterization (UC) on skin temperature and cardiorespiratory status in preterm infants.Materials and methods: In a prospective observational study of infants <32 weeks of gestation, the duration of UC, course of skin temperature, and cardiorespiratory status were registered. Hypothermia was defined as a temperature below 36.5C.Results: UC was performed in 55 infants with a median (range) gestational age of 28 weeks (24-31) and birth weight of 1120g (625-2091). Mean (SD) temperature first decreased 0.6 (0.6)degrees C during UC followed by a rise of 0.4 (0.4)degrees C after reaching the minimal temperature. Hypothermia already existed in 69% (38/55) of the infants before start of UC, which increased to 89% (49/55) during UC (p = .001). Duration of UC was not associated with the development of hypothermia during the procedure (p = .48). Heart rate (mean(SD)) significantly increased (162 (17) versus 152 (15); p <.001) and there was a trend toward an increase in supplemental oxygen (mean(SD)) (0.31 (0.17) versus 0.28 (0.13); p = .78), but both changes were only temporary.Conclusion: Hypothermia was frequent in preterm infants before start of UC and increased during UC. Postponing UC until the infant has a normal temperature should be considered. Show less
