In this thesis we have investigated spontaneous breathing as a possible driving force for placental transfusion and the implementation of PBCC in a clinical setting. Spontaneous breathing at birth,... Show moreIn this thesis we have investigated spontaneous breathing as a possible driving force for placental transfusion and the implementation of PBCC in a clinical setting. Spontaneous breathing at birth, and lung aeration, is pivotal to accomplish the increase in pulmonary blood flow and decrease in pulmonary vascular resistance needed for a successful transition to extra-uterine life. Indeed, we demonstrated spontaneous breathing to influence umbilical blood flow and to potentially create a preferential blood flow from the placenta towards the infant. Based on this thesis we have therefore concluded that spontaneous breathing is likely to be a driving force in placental transfusion. In addition, we investigated physiological-based cord clamping (PBCC). Experimental studies clearly demonstrated the beneficial physiological effects of PBCC and that lung aeration, with the subsequent increase in pulmonary blood flow, is vital for the success of this approach. The studies in this thesis demonstrate the proof of concept for performing PBCC in preterm infants in a clinical setting: that it is both possible and safe, and that a similar effect can be observed as in an experimental setting. We also demonstrated that resuscitation on the cord is at least as effective, while allowing longer and variable cord clamping times. Show less
We report a case of a monochorionic diamniotic twin diagnosed with twin-twin transfusion syndrome (TTTS; stage 3) with co-existing severe cerebral damage in the donor twin at 18 + 4 weeks'... Show moreWe report a case of a monochorionic diamniotic twin diagnosed with twin-twin transfusion syndrome (TTTS; stage 3) with co-existing severe cerebral damage in the donor twin at 18 + 4 weeks' gestation. After counselling, the parents opted for selective foeticide of the donor twin. For the procedure, radiofrequency ablation (RFA) was used. Serial ultrasound examinations at 20 + 1 and 21 + 1 weeks' gestation showed good recovery of the ex-recipient, after which the patient was sent back to the referring hospital. At 29 + 5 weeks' gestation, an unexpected foetal death was diagnosed. On macroscopic placental examination, (iatrogenic) monoamnionicity was detected. In addition, the umbilical cord of the recipient was found to be constricted by the macerated umbilical cord of the ex-donor. This case demonstrates that iatrogenic monoamnionicity can be a serious complication of RFA in monochorionic twins complicated by TTTS, with a subsequent risk for cord entanglement leading to a fatal outcome for the remaining co-twin. Although the actual incidence of iatrogenic monoamnionicity after RFA remains unknown, increased attention to the intactness of the inter-twin membrane even weeks after the RFA may be required. Show less
The umbilical cord and cord blood contain stem cells that can be used for regenerative cell therapies such as hematopoietic stem cell transplantation. However, the application of cord blood is... Show moreThe umbilical cord and cord blood contain stem cells that can be used for regenerative cell therapies such as hematopoietic stem cell transplantation. However, the application of cord blood is hindered by the slow engraftment of the cells and delayed immune reconstitution compared to stem cells of other sources such as bone marrow. This thesis focuses on ways to improve CB application from both the perspective of the patient (i.e. better engraftment) as well as from the cost perspective (i.e. wider applicability). To this aim, we investigated (combinations of) methods for the improvement of CB engraftment in a murine engraftment model for human hematopoietic cells. Besides our focus on the PB recovery of platelets and CD45+ cells, we furthermore looked at practical aspects of the application of CB such as the possibility of banking expanded cells, banking CB for other purposes than HST and the use of other extra-fetal (embryonic) tissues such as the umbilical cord. Show less
