This thesis presents an update on maternal mortality in the Netherlands, and its association with mode of birth. Additionally, the second part demonstrates the differences in maternal morbidity, in... Show moreThis thesis presents an update on maternal mortality in the Netherlands, and its association with mode of birth. Additionally, the second part demonstrates the differences in maternal morbidity, in particular peripartum hysterotomy, between European high-income countries as well as worldwide. Show less
The incidence of postpartum hemorrhage is rising and may lead to severe maternal morbidity and maternal mortality. In this manuscript we investigated women in need of massive blood transfusion... Show moreThe incidence of postpartum hemorrhage is rising and may lead to severe maternal morbidity and maternal mortality. In this manuscript we investigated women in need of massive blood transfusion because of postpartum hemorrhage in order to improve our understanding of postpartum hemorrhage associated with severe maternal outcome and to compare management strategies and maternal outcome between different settings. Furthermore, we evaluated maternity care at different stages of bleeding following childbirth, i.e.: onset of hemorrhage (timely recognition of women at risk of progression of hemorrhage), persistent hemorrhage (evaluation of obstetric interventions to cease persistent hemorrhage), and end of hemorrhage (learn lessons once a maternal death from obstetric hemorrhage has occurred). Show less
Henriquez, D.D.C.A.; Gillissen, A.; Smith, S.M.; Cramer, R.A.; Akker, T. van den; Zwart, J.J.; ... ; TeMpOH-1 Study Grp 2019
Background The absence of a uniform and clinically relevant definition of severe postpartum haemorrhage hampers comparative studies and optimization of clinical management. The concept of... Show moreBackground The absence of a uniform and clinically relevant definition of severe postpartum haemorrhage hampers comparative studies and optimization of clinical management. The concept of persistent postpartum haemorrhage, based on refractoriness to initial first-line treatment, was proposed as an alternative to common definitions that are either based on estimations of blood loss or transfused units of packed red blood cells (RBC). We compared characteristics and outcomes of women with severe postpartum haemorrhage captured by these three types of definitions. Methods In this large retrospective cohort study in 61 hospitals in the Netherlands we included 1391 consecutive women with postpartum haemorrhage who received either >= 4 units of RBC or a multicomponent transfusion. Clinical characteristics and outcomes of women with severe postpartum haemorrhage defined as persistent postpartum haemorrhage were compared to definitions based on estimated blood loss or transfused units of RBC within 24 h following birth. Adverse maternal outcome was a composite of maternal mortality, hysterectomy, arterial embolisation and intensive care unit admission. Results One thousand two hundred sixty out of 1391 women (90.6%) with postpartum haemorrhage fulfilled the definition of persistent postpartum haemorrhage. The majority, 820/1260 (65.1%), fulfilled this definition within 1 h following birth, compared to 819/1391 (58.7%) applying the definition of >= 1 L blood loss and 37/845 (4.4%) applying the definition of >= 4 units of RBC. The definition persistent postpartum haemorrhage captured 430/471 adverse maternal outcomes (91.3%), compared to 471/471 (100%) for >= 1 L blood loss and 383/471 (81.3%) for >= 4 units of RBC. Persistent postpartum haemorrhage did not capture all adverse outcomes because of missing data on timing of initial, first-line treatment. Conclusion The definition persistent postpartum haemorrhage identified women with severe postpartum haemorrhage at an early stage of haemorrhage, unlike definitions based on blood transfusion. It also captured a large majority of adverse maternal outcomes, almost as large as the definition of >= 1 L blood loss, which is commonly applied as a definition of postpartum haemorrhage rather than severe haemorrhage. Show less
Schaap, T.P.; Overtoom, E.; Akker, T. van den; Zwart, J.J.; Roosmalen, J. van; Bloemenkamp, K.W.M. 2019
Background: Maternal cardiac arrest is a complex and demanding clinical situation requiring a well-attuned team effort of healthcare workers of multiple disciplines. A recent report on maternal... Show moreBackground: Maternal cardiac arrest is a complex and demanding clinical situation requiring a well-attuned team effort of healthcare workers of multiple disciplines. A recent report on maternal cardiac arrest in the United Kingdom reported a rise in incidence over a span of 10 years, while maternal mortality increased in the United States between 2000 and 2014. However, reported causes of maternal cardiac arrest differed between both countries.Objective(s): To determine the incidence, causes and management of maternal cardiac arrest in the Netherlands and compare incidence with previous estimates in the Netherlands and the United Kingdom.Study design: Using the Netherlands Obstetric Surveillance System, all Dutch cases of maternal cardiac arrest during a three-year period (2013-2016) were prospectively collected. Complete casefile copies were obtained for analysis. Main outcome measures were incidence of maternal cardiac arrest and cardiac arrest in pregnancy, use of perimortem caesarean section if appropriate and maternal death.Results: The monthly card return rate was 97%; 18 women with cardiac arrest during pregnancy and 20 postpartum met the inclusion criteria. Incidence of maternal cardiac arrest was 7.6 per 100,000 pregnancies and 3.6 per 100,000 pregnancies excluding postpartum maternal cardiac arrest. Main causes were pulmonary embolism (n = 9), major obstetric hemorrhage (n = 7) and amniotic fluid embolism (n = 6). Aortocaval compression relief and perimortem caesarean section were performed in 9/14 (29%) and 11/14 (79%) respectively in pregnancies 20 weeks gestational age onwards. Twenty-two women died, representing a case fatality rate of 58% (95% CI 42-72%).Conclusion(s): There is a higher incidence of cardiac arrest in pregnancy compared to both previous estimates in the Netherlands and recently established figures in the United Kingdom. Main causes of maternal cardiac arrest are potentially preventable and/or treatable complications of pregnancy. Insufficient use of critical elements of obstetric resuscitation identifies the need for enhanced obstetric emergency training for obstetric and non-obstetric first responders. (C) 2019 Elsevier B.V. All rights reserved. Show less
Background: Namibia, a middle-income country in sub-Saharan Africa (SSA), plans to use the Maternal Near Miss (MNM) approach. Adaptations of the World Health Organization (WHO) MNM defining... Show moreBackground: Namibia, a middle-income country in sub-Saharan Africa (SSA), plans to use the Maternal Near Miss (MNM) approach. Adaptations of the World Health Organization (WHO) MNM defining criteria ('WHO MNM criteria') were previously proposed for low-income settings in sub-Saharan Africa ('SSA MNM criteria'), but whether these adaptations are required in middle-income settings is unknown. Objective: To establish MNM criteria suitable for use in Namibia, a middle-income country in SSA. Methods: Cross-sectional study from 1 March 2018 to 31 May 2018 in four Namibian hospitals. Pregnant women or within 42 days of termination of pregnancy or birth, fulfilling at least one WHO or SSA MNM criterion were included. Records of women identified by either only WHO criteria or only SSA criteria were assessed in detail. Results: 194 Women fulfilled any MNM criterion. WHO criteria identified 61 MNM, the SSA criteria 184 MNM. Of women who only fulfilled any of the unique SSA MNM criteria, 18 fulfilled the criterion 'eclampsia', one 'uterine rupture' and five 'laparotomy'. These women were assessed to be MNM. Thresholds for blood transfusion to define MNM due to haemorrhage were two units in the SSA and five in WHO set. Two or three units were given to 95 women for mild/moderate haemorrhage or chronic anaemia who did not fulfil any WHO criterion and were not considered MNM. Fourteen women who were assessed to be MNM from severe haemorrhage received four units. Conclusions: WHO MNM criteria may underestimate and SSA MNM criteria overestimate the prevalence of MNM in a middle-income country such as Namibia, where MNM criteria 'in between' may be more appropriate. Namibia opts to apply a modification of the WHO criteria, including eclampsia, uterine rupture, laparotomy and a lower threshold of four units of blood to define MNM. We recommend that other middle-income countries validate our criteria for their setting. Show less
Nolens, B.; Namiiro, F.; Lule, J.; Akker, T. van den; Roosmalen, J. van; Byamugisha, J. 2018
Using the results from a two-year nationwide prospective study, this thesis shows numerous (risk) factors associated with severe acute maternal morbidity (SAMM) in the Netherlands and validates... Show moreUsing the results from a two-year nationwide prospective study, this thesis shows numerous (risk) factors associated with severe acute maternal morbidity (SAMM) in the Netherlands and validates the WHO Maternal Near Miss (MNM) tool to detect and monitor SAMM worldwide. The ratio behind the different subjects selected in this thesis is explained by differences in economic disparity throughout the globe. Where the effect of poverty is undeniably present in maternal health care, we hypothesize that wealth might also have a negative impact on pregnancy outcome. Show less
Hanegem, N. van; Miltenburg, A.S.; Zwart, J.J.; Bloemenkamp, K.W.M.; Roosmalen, J. van 2011
