Rise in maternal mortality in the Netherlands Schutte, JM; Steegers, EAP; Schuitemaker, NWE ...
BJOG : an international journal of obstetrics and gynaecology,
March 2010, Letnik:
117, Številka:
4
Journal Article
Recenzirano
Odprti dostop
Please cite this paper as: Schutte J, Steegers E, Schuitemaker N, Santema J, de Boer K, Pel M, Vermeulen G, Visser W, van Roosmalen J, the Netherlands Maternal Mortality Committee. Rise in maternal ...mortality in the Netherlands. BJOG 2009;117:399–406.
Objective To assess causes, trends and substandard care factors in maternal mortality in the Netherlands.
Design Confidential enquiry into the causes of maternal mortality.
Setting Nationwide in the Netherlands.
Population 2,557,208 live births.
Methods Data analysis of all maternal deaths in the period 1993–2005.
Main outcome measures Maternal mortality.
Results The overall maternal mortality ratio was 12.1 per 100 000 live births, which was a statistically significant rise compared with the maternal mortality ratio of 9.7 in the period 1983–1992 (OR 1.2, 95% CI 1.0–1.5). The most frequent direct causes were (pre‐)eclampsia, thromboembolism, sudden death in pregnancy, sepsis, obstetric haemorrhage and amniotic fluid embolism. The number of indirect deaths also increased, mainly caused by an increase in cardiovascular disorders (OR 2.5, 95% CI 1.4–4.6). Women younger than 20 years and older than 45 years, those with high parity or from nonwestern immigrant populations were at higher risk. Most substandard care was found in women with pre‐eclampsia (91%) and in immigrant populations (62%).
Conclusions Maternal mortality in the Netherlands has increased since 1983–1992. Pre‐eclampsia remains the number one cause. Groups at higher risk for complications during pregnancy should be better identified early in pregnancy or before conception, in order to receive preconception advice and more frequent antenatal visits. There is an urgent need for the better education of women and professionals concerning the danger signs, and for the training of professionals in order to improve maternal health care.
Zusammenfassung
Bisher verfügbare Daten klinischer Tumorregister zeigen positive Entwicklungen in der Versorgungsqualität der Primärtumorbehandlung. Am Beispiel der am umfangreichsten dokumentierten ...Entitäten, den Mamma- und Kolorektalkarzinomen, werden aber noch deutliche Versorgungsdefizite v. a. in der System- und Strahlentherapie erkennbar. Für andere häufige Tumoren sowie für seltene Tumorerkrankungen und Patienten mit metastasierter Erkrankung sind verlässliche Daten zur Versorgungsqualität weitgehend nicht verfügbar. Die Förderung klinischer Krebsregister und sektorübergreifender interdisziplinärer Tumorzentren, an denen alle an der Tumorbehandlung maßgeblich beteiligten Disziplinen obligat beteiligt sind, erscheint geeignet, bestehende Strukturdefizite zu minimieren.
Abstract The axion emerges in extensions of the Standard Model that explain the absence of CP violation in the strong interactions. Simultaneously, it can provide naturally the cold dark matter in ...our universe. Several searches for axions and axion-like particles (ALPs) have constrained the corresponding parameter space over the last decades but no unambiguous hints of their existence have been found. The axion mass range below 1 meV remains highly attractive and a well motivated region for dark matter axions. In this White Paper we present a description of a new experiment based on the concept of a dielectric haloscope for the direct search of dark matter axions in the mass range of 40 to 400 $$\upmu \hbox {eV}$$ μeV . This MAgnetized Disk and Mirror Axion eXperiment (MADMAX) will consist of several parallel dielectric disks, which are placed in a strong magnetic field and with adjustable separations. This setting is expected to allow for an observable emission of axion induced electromagnetic waves at a frequency between 10 to 100 GHz corresponding to the axion mass.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Please cite this paper as: Dijkman A, Huisman C, Smit M, Schutte J, Zwart J, van Roosmalen J, Oepkes D. Cardiac arrest in pregnancy: increasing use of perimortem caesarean section due to emergency ...skills training? BJOG 2010;117:282–287.
Objective Management of cardiac arrest in pregnancy is recommended to include perimortem caesarean section (PMCS) in the Managing Obstetric Emergencies and Trauma (MOET) course. In this study, we aimed to assess maternal and neonatal outcome of all cases of PMCS in the Netherlands performed in the last 15 years, and to test the hypothesis that PMCS was used more often since the introduction of the MOET‐course in 2004.
Design Retrospective cohort study.
Setting Nationwide assessment of all cases of PMCS inside or outside hospitals.
Population All known cases of PMCS in the Netherlands from 1993 to 2008.
Methods Data collection through contacting all Dutch obstetricians and all MOET and Advanced Trauma Life Support instructors. All cases of cardiac arrest during pregnancy were collected by cross‐checking with data from the Dutch Maternal Mortality Committee and a nationwide severe maternal morbidity study.
Main outcome measures Incidence and case fatality rate of PMCS. Incidence of PMCS before and after introduction of the MOET course. Maternal and neonatal outcome and the process of the PMCS were analysed.
Results During the study period, 55 women had a cardiac arrest, 12 of whom underwent a PMCS. Before the introduction of the MOET course, four PMCSs were performed (0.36/year), compared with eight cases after its introduction (1.6/year, P = 0.01). No PMCS was performed within the recommended 5 minutes after starting resuscitation. Eight of the twelve women (67%) regained cardiac output after PMCS, with two maternal and five neonatal survivors. Maternal case fatality rate was 83%. Neonatal case fatality rate was 58%.
Conclusions Since the introduction of the MOET course, the use of PMCS has increased. Outcome, however, was still poor. An important factor to improve outcome is more timely application of this potentially life‐saving procedure.
Abstract Cytokines, chemokines, and growth factors were analyzed periodically over eight weeks from the wound exudate fluid surrounding biomaterials implanted subcutaneously within stainless steel ...mesh cages. TNF-α, MCP-1, MIP-1α, IL-2, IL-6, IL-1β, VEGF, IL-4, and IL-10 were measured from exudate samples collected from cages containing specimens of polyethylene (PE), polyurethane (PU), or organotin polyvinyl chloride (ot-PVC). Empty cages served as negative controls, and lipopolysaccharide (LPS) served as a positive control. Cytokine, chemokine, and growth factor concentrations decreased from the time of implantation to eight weeks post-implantation, and there was an overall increase in cytokine, chemokine, and growth factor production for material-containing cages compared to empty cages. However, cytokine production was only modestly affected by the different surface chemistries of the three implanted polymeric materials.
We present 3D calculations for dielectric haloscopes such as the currently envisioned MADMAX experiment. For ideal systems with perfectly flat, parallel and isotropic dielectric disks of finite ...diameter, we find that a geometrical form factor reduces the emitted power by up to 30 % compared to earlier 1D calculations. We derive the emitted beam shape, which is important for antenna design. We show that realistic dark matter axion velocities of 10-3 c and inhomogeneities of the external magnetic field at the scale of 10 % have negligible impact on the sensitivity of MADMAX. We investigate design requirements for which the emitted power changes by less than 20 % for a benchmark boost factor with a bandwidth of 50 MHz at 22 GHz, corresponding to an axion mass of 90 μ eV. We find that the maximum allowed disk tilt is 100 μ m divided by the disk diameter, the required disk planarity is 20 μ m (min-to-max) or better, and the maximum allowed surface roughness is 100 μ m (min-to-max). We show how using tiled dielectric disks glued together from multiple smaller patches can affect the beam shape and antenna coupling.
Heavy metals and metalloids (HMs) are environmental pollutants, most notably cadmium, lead, arsenic, mercury, and chromium. When HMs accumulate to toxic levels in agricultural soils, these ...non-biodegradable elements adversely affect crop health and productivity. The toxicity of HMs on crops depends upon factors including crop type, growth condition, and developmental stage; nature of toxicity of the specific elements involved; soil physical and chemical properties; occurrence and bioavailability of HM ions in the soil solution; and soil rhizosphere chemistry. HMs can disrupt the normal structure and function of cellular components and impede various metabolic and developmental processes. This review evaluates: (1) HM contamination in arable lands through agricultural practices, particularly due to chemical fertilizers, pesticides, livestock manures and compost, sewage-sludge-based biosolids, and irrigation; (2) factors affecting the bioavailability of HM elements in the soil solution, and their absorption, translocation, and bioaccumulation in crop plants; (3) mechanisms by which HM elements directly interfere with the physiological, biochemical, and molecular processes in plants, with particular emphasis on the generation of oxidative stress, the inhibition of photosynthetic phosphorylation, enzyme/protein inactivation, genetic modifications, and hormonal deregulation, and indirectly through the inhibition of soil microbial growth, proliferation, and diversity; and (4) visual symptoms of highly toxic non-essential HM elements in plants, with an emphasis on crop plants. Finally, suggestions and recommendations are made to minimize crop losses from suspected HM contamination in agricultural soils.
BACKGROUND We assessed all deaths in the Netherlands that might have been related to IVF or to an IVF pregnancy in order to investigate this most serious complication. METHODS All deaths related to ...IVF, within 1 year after IVF, from 1984 to 2008 were collected by sending a letter to all gynaecologists, and by retrieving data from a large cohort study examining the late effects of ovarian stimulation (OMEGA) and from the Dutch Maternal Mortality Committee. RESULTS Six deaths were directly related to IVF (6/100 000), 17 deaths were directly related to the IVF pregnancy (42.5/100 000) and eight deaths were neither related to the IVF nor to the IVF-related pregnancy. The overall mortality in patients undergoing IVF procedures was lower than in the general population, whereas the overall mortality related to IVF pregnancies was higher than the maternal mortality in the general population. CONCLUSION The decreased mortality is probably the result of a ‘healthy female effect’ in women undergoing IVF. The high maternal mortality in IVF pregnancies is probably related to the high number of multiple pregnancies and to the fact that (donor egg) IVF is successfully used in women who are older. The fact that only a few deaths directly related to IVF are reported in the literature whereas we observed six in the Netherlands indicates worldwide under-reporting of IVF-related mortality. We underline the importance of reporting all lethal cases to the European Society of Human Reproduction and Embryology Committee ‘Safety and Quality after IVF’.
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