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
Objective: Assess improvable care factors in late preterm mortality, defined as death of a child during labour or in the first 28 days thereafter between 32 + 0 and 36 + 6 weeks gestation, in the... Show moreObjective: Assess improvable care factors in late preterm mortality, defined as death of a child during labour or in the first 28 days thereafter between 32 + 0 and 36 + 6 weeks gestation, in the Netherlands.Design: Perinatal audit has been coordinated and supported at the national level, with selection of nationwide audit themes, and audit sessions are performed at the local level across the country as multidisciplinary meetings with primary and secondary level health care professionals, organised in local perinatal cooperation units. In 2017-2019, late preterm mortality was such a theme. We compiled and systematically categorised all improvable care factors formulated during local audit meetings in a national perinatal audit database.Results: In total, 27 cases were discussed in local perinatal audits and analysed locally and at the national level. Altogether, 52 improvable care factors were identified. Most identified improvable care factors concerned inadequate foetal monitoring by cardiotocography during labour, factors related to care organisation, particularly unclarity around local assigning of responsibilities and work procedures, and poor communication between involved health care professionals especially in transfer of care.Conclusion: Several critical improvable care factors were identified through nationwide perinatal audit of late preterm deaths in the Netherlands. Show less
While facility births are increasing in many low-resource settings, quality of care often does not follow suit; maternal and perinatal mortality and morbidity remain unacceptably high. Therefore,... Show moreWhile facility births are increasing in many low-resource settings, quality of care often does not follow suit; maternal and perinatal mortality and morbidity remain unacceptably high. Therefore, realistic, context-tailored clinical support is crucially needed to assist birth attendants in resource-constrained realities to provide best possible evidence-based and respectful care. Our pilot study in Zanzibar suggested that co-created clinical practice guidelines (CPGs) and low-dose, high-frequency training (PartoMa intervention) were associated with improved childbirth care and survival. We now aim to modify, implement, and evaluate this multi-faceted intervention in five high-volume, urban maternity units in Dar es Salaam, Tanzania (approximately 60,000 births annually). This PartoMa Scale-up Study will include four main steps: I. Mixed-methods situational analysis exploring factors affecting care; II. Co-created contextual modifications to the pilot CPGs and training, based on step I; III. Implementation and evaluation of the modified intervention; IV. Development of a framework for co-creation of context-specific CPGs and training, of relevance in comparable fields. The implementation and evaluation design is a theory-based, stepped-wedged cluster-randomised trial with embedded qualitative and economic assessments. Women in active labour and their offspring will be followed until discharge to assess provided and experienced care, intra-hospital perinatal deaths, Apgar scores, and caesarean sections that could potentially be avoided. Birth attendants' perceptions, intervention use and possible associated learning will be analysed. Moreover, as further detailed in the accompanying article, a qualitative in-depth investigation will explore behavioural, biomedical, and structural elements that might interact with non-linear and multiplying effects to shape health providers' clinical practices. Finally, the incremental cost-effectiveness of co-creating and implementing the PartoMa intervention is calculated. Such real-world scale-up of context-tailored CPGs and training within an existing health system may enable a comprehensive understanding of how impact is achieved or not, and how it may be translated between contexts and sustained. Trial registration number: NCT04685668 Show less
Heuvel, J.F.M. van den; Hogeveen, M.; Holzik, M.L.; Heijst, A.F.J. van; Bekker, M.N.; Geurtzen, R. 2022
Background In case of extreme premature delivery at 24 weeks of gestation, both early intensive care and palliative comfort care for the neonate are considered treatment options. Prenatal... Show moreBackground In case of extreme premature delivery at 24 weeks of gestation, both early intensive care and palliative comfort care for the neonate are considered treatment options. Prenatal counseling, preferably using shared decision making, is needed to agree on the treatment option in case labor progresses. This article described the development of a digital decision aid (DA) to support pregnant women, partners and clinicians in prenatal counseling for imminent extreme premature labor. Methods This DA is developed following the International Patient Decision Aid Standards. The Dutch treatment guideline and the Dutch recommendations for prenatal counseling in extreme prematurity were used as basis. Development of the first prototype was done by expert clinicians and patients, further improvements were done after alpha testing with involved clinicians, patients and other experts (n = 12), and beta testing with non-involved clinicians and patients (n = 15). Results The final version includes information, probabilities and figures depending on users' preferences. Furthermore, it elicits patient values and provides guidance to aid parents and professionals in making a decision for either early intensive care or palliative comfort care in threatening extreme premature delivery. Conclusion A decision aid was developed to support prenatal counseling regarding the decision on early intensive care versus palliative comfort care in case of extreme premature delivery at 24 weeks gestation. It was well accepted by parents and healthcare professionals. Our multimedia, digital DA is openly available online to support prenatal counseling and personalized, shared decision-making in imminent extreme premature labor. Show less
Straneo, M.; Benova, L.; Hanson, C.; Fogliati, P.; Pembe, A.B.; Smekens, T.; Akker, T. van den 2021
Proportions of facility births are increasing throughout sub-Saharan Africa, but obstetric services vary within the health system. In Tanzania, advanced management of childbirth complications ... Show moreProportions of facility births are increasing throughout sub-Saharan Africa, but obstetric services vary within the health system. In Tanzania, advanced management of childbirth complications (comprehensive emergency obstetric care) is offered in hospitals, while in frontline, primary health care (PHC) facilities (health centres and dispensaries) mostly only routine childbirth care is available. With over half (54%) of rural births in facilities, we hypothesized the presence of socio-economic inequity in hospital-based childbirth uptake in rural Tanzania and explored whether this relationship was modified by parity. This inequity may compound the burden of greater mortality among the poorest women and their babies. Records for 4456 rural women from the 2015-16 Tanzania Demographic and Health Survey with a live birth in the preceding 5years were examined. Proportions of births at each location (home/PHC/hospital) were calculated by demographic and obstetric characteristics. Multinomial logistic regression was used to obtain crude and adjusted odds ratios of home/PHC and hospital/PHC births based on household wealth, including interaction between wealth and parity. Post-estimation margins analysis was applied to estimate childbirth location by wealth and parity. Hospital-based childbirth uptake was inequitable. The gap between poorest and richest was less pronounced at first birth. Hospital-based care utilization was lowest (around 10%) among the poorest multiparous women, with no increase at high parity (>= 5) despite higher risk. PHC-based childbirth care was used by a consistent proportion of women after the first birth (range 30-51%). The poorest women utilized it at intermediate parity, but at parity >= 5 mostly gave birth at home. In an effort to provide effective childbirth care to all women, context-specific strategies are required to improve hospital-based care use, and poor, rural, high parity women are a particularly vulnerable group that requires specific attention. Improving childbirth care in PHC and strengthening referral linkages would benefit a considerable proportion of women. Show less
Lips, S.R.; Molenaar, J.M.; Schuitmaker-Warnaar, T.J. 2020
Increasing continuity in Dutch maternity care is considered pivotal to improve safety and client-centeredness. Closer collaboration between the historically relatively autonomous professionals and... Show moreIncreasing continuity in Dutch maternity care is considered pivotal to improve safety and client-centeredness. Closer collaboration between the historically relatively autonomous professionals and organizations in maternity care is deemed conditional to reach this goal, both by maternity care professionals and policy makers. Governmental policy therefore strives for organizational and financial integration. One of the policy measures has been to stimulate interprofessional and interorganizational collaboration through local obstetric partnerships. This study aimed to gain insight into whether this policy measure supported professionals in reaching the policy aim of increasing integration in the maternity care system. We therefore conducted 73 semistructured interviews with maternity care professionals in the region Northwest Netherlands, from 2014 to 2016. Respondents expressed much willingness to intensify interprofessional and interorganizational collaboration and experienced obstetric partnerships as contributing to this. As such, stimulating integration through obstetric partnerships can be considered a suitable policy measure. However, collaborating within the partnerships simultaneously highlighted deep-rooted dividing structures (organizational, educational, legal, financial) in the maternity care system, especially at the systemic level. These were experienced to hinder collaboration, but difficult for the professionals to influence, as they lacked knowledge, skills, resources and mandate. A lack of clear and timely guidance and support from policy, counterbalancing these barriers, limited partnerships' potential to unify professionals and integrate their services. (C) 2020 Elsevier B.V. All rights reserved. Show less
Laureij, L.T.; Been, J.V.; Lugtenberg, M.; Ernst-Smelt, H.E.; Franx, A.; Hazelzet, J.A.; ... ; PCB Outcome Set Study Grp Collabor 2020
Objective: The International Consortium for Health Outcomes Measurement developed the Pregnancy and Childbirth (PCB) outcome set to improve value-based perinatal care. This set contains clinician... Show moreObjective: The International Consortium for Health Outcomes Measurement developed the Pregnancy and Childbirth (PCB) outcome set to improve value-based perinatal care. This set contains clinician-reported outcomes and patient-reported outcomes. We validated the set for use in the Netherlands by exploring its applicability among all end-users prior to implementation.Methods: A mixed-methods design was applied. A survey was performed to assess patients (n = 142), professionals (n = 134) and administrators (n = 35) views on the PCB set. To further explore applicability, separate focus groups were held with representatives of each of these groups.Results: The majority of survey participants agreed that the PCB set contains the most important outcomes. Patient-reported experience measures were considered relevant by the majority of participants. Perceived relevance of patient-reported outcome measures varied. Main themes from the focus groups were content of the set, data collection timing, implementation (also IT and transparency), and quality-based governance.Conclusion: This study supports suitability of the PCB outcome set for implementation, evaluation of quality of care and shared decision making in perinatal care.Practice Implications: Implementation of the PCB set may change existing care pathways of perinatal care. Focus on transparency of outcomes is required in order to achieve quality-based governance with proper IT solutions. (C) 2019 The Authors. Published by Elsevier B.V. Show less
Kallianidis, A.F.; Schutte, J.M.; Roosmalen, J. van; Akker, T. van den; Netherlands Soc Obstet Gynecology 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
Boere, I.; Smit, M.; Roest, A.A.W.; Lopriore, E.; Lith, J.M.M. van; Pas, A.B. te 2015
The aim of this dissertation is outlined in the introduction, which includes a paragraph on physiology and pathophysiology of the third stage of labour. The next paragraph handles the management of... Show moreThe aim of this dissertation is outlined in the introduction, which includes a paragraph on physiology and pathophysiology of the third stage of labour. The next paragraph handles the management of the third stage of labour. Furthermore, the clinical problems __retained placenta__ and __puerperal uterine inversion__ are outlined. In the last paragraph, the terms __quality of life__ and __illness perceptions__ are clarified. Part 2 of this dissertation contains the Dutch contribution to explore a possible global rise in incidence of postpartum haemorrhage (chapter 1). The current knowledge and practice regarding active management of the third stage of labour in midwifery practices and obstetric departments in the Netherlands is presented (chapter 2). In part 3 of this dissertation, the problems associated with abnormal placentation are explored. Misoprostol turned out not to be beneficial over placebo in the management of retained placenta (chapter 3 and 4). In chapter 5, a cohort of fifteen women with puerperal inversion of the uterus is presented. Experiencing an event such as major obstetric haemorrhage does not seem to be associated with diminished quality of life. Clinical characteristics imply a big impact of the event on women and their partners. Show less
In the 1980s prostaglandin analogues were introduced for induction of labour without good evidence of superiority over older methods, such as Foley catheter. The aim of this thesis was to... Show moreIn the 1980s prostaglandin analogues were introduced for induction of labour without good evidence of superiority over older methods, such as Foley catheter. The aim of this thesis was to investigate the use of Foley catheter as an induction agent in women with an unfavourable cervix at term, compared to prostaglandins. The studies in this thesis demonstrate that Foley catheter yields similar caesarean sectio rates compared to vaginally administered prostaglandins, making both methods equally effective. Findings from RCTs and meta-analysis in this dissertation show reduced side effects with Foley catheter. Costs are comparable, and could further be reduced in favour of Foley catheter when used in an outpatient setting. This makes Foley catheter a superior method, with potential for outpatient cervical ripening, cervical ripening in low-resource settings, and cervical ripening in women with prior caesarean birth. Show less
Lonkhuijzen, L. van; Roosmalen, J. van; Zeeman, G. 2011
