Objective
To describe characteristics, risk factors and maternal, obstetric and neonatal outcomes of pregnant women infected with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2).
Design
...Multi‐centre prospective population‐based cohort study.
Setting
Nationwide study in the Netherlands.
Population
Pregnant women with confirmed SARS‐CoV‐2 infection admitted to hospital or in home‐isolation: 1 March 2020 to 31 August 2020.
Methods
Pregnant women with positive polymerase chain reaction or antibody tests were registered using the Netherlands Obstetrics Surveillance System (NethOSS). (Selective) testing occurred according to national guidelines. Data from the national birth registry (pregnant pre‐coronavirus disease 2019 COVID‐19 cohort) and an age‐matched cohort of COVID‐19‐positive women (National Institute for Public Health and the Environment; fertile age COVID‐19 cohort) were used as reference.
Main outcome measures
Incidence of SARS‐CoV‐2 infection in pregnant women. Maternal, obstetric and neonatal outcomes including hospital and intensive care admission.
Results
Of 376 registered pregnant women with confirmed SARS‐CoV‐2 infection, 20% (74/376) were admitted to hospital, of whom 84% (62/74) were due to SARS‐CoV‐2; 10% (6/62) were admitted to intensive care and 15% (9/62) to obstetric high‐care units. Risk factors for admission were non‐European country of origin (odds ratio OR 1.73, 95% CI 1.01–2.96) and being overweight/obese (OR 1.86, 95% CI 1.51–3.20). No maternal or perinatal deaths occurred. Caesarean section after labour‐onset was increased (OR 1.58, 95% CI 1.09–2.28). Hospital and intensive care admission were higher compared with the fertile age COVID‐19 cohort (OR 6.75, 95% CI 5.18–8.81 and OR 2.52, 95% CI 1.11–5.77, respectively).
Conclusions
Non‐European country of origin and being overweight/obese are risk factors for severe course of SARS‐CoV‐2 infection in pregnancy, risk of caesarean section and hospital and intensive care unit admission are increased.
Tweetable
Pregnant women with SARS‐CoV‐2 in the Netherlands show increased hospital/ICU admission and caesarean section.
Tweetable
Pregnant women with SARS‐CoV‐2 in the Netherlands show increased hospital/ICU admission and caesarean section.
This article includes Author Insights, a video available at: https://vimeo.com/bjog/authorinsights16903
Objective
To compare incidences, characteristics, management and outcome of eclampsia in the Netherlands and the UK.
Design
A comparative analysis of two population‐based prospective cohort studies.
...Setting
All hospitals with consultant‐led maternity units.
Population
Women with eclampsia in the Netherlands (226) and the UK (264).
Methods
Comparison of individual level data from national studies in the Netherlands and the UK (LEMMoN 2004–06; UKOSS 2005/06).
Main outcome measures
Incidence, maternal complications and differences in management strategies.
Results
Incidences of eclampsia differed significantly between both countries: the Netherlands 5.4/10 000 deliveries versus UK 2.7/10 000 (relative risk RR 1.94, 95% confidence intervals 95% CI 1.6–2.4). The proportion of women with a preceding diagnosis of pre‐eclampsia was comparable between both countries (the Netherlands 42%; UK 43%), as was the proportion who received magnesium sulphate prophylaxis. Women in the Netherlands had a significantly higher maximum diastolic blood pressure (111 mmHg versus 95 mmHg, P < 0.001); significantly fewer received anti‐hypertensive medication (16% versus 71%; RR 0.2, 95% CI 0.1–0.3) and were treated less often with magnesium sulphate after their first fit (95% versus 99%; RR 0.96, 95% CI 0.92–0.99). Maternal death occurred in three cases in the Netherlands compared with zero in the UK.
Conclusions
The incidence of eclampsia in the Netherlands was twice as high compared with the UK when using uniform definitions. Women with eclampsia in the Netherlands were not managed according to guidelines, particularly with respect to blood pressure management. Changes in management practice may reduce both incidence and poor outcomes.
Please cite this paper as: Schaap T, Schutte J, Zwart J, Schuitemaker N, van Roosmalen J. Fatal meningitis during pregnancy in the Netherlands: a nationwide confidential enquiry. BJOG ...2012;119:1558–1563.
Objective To determine the incidence of maternal deaths attributable to meningitis in the Netherlands, and to assess clinical features and risk factors.
Design Confidential enquiry into the causes of maternal deaths.
Setting Nationwide in the Netherlands.
Population A total of 4 784 408 live births.
Methods Analysis of all maternal deaths due to meningitis in pregnancy and puerperium from 1983 up to and including 2007 reported to the Maternal Mortality Committee of the Dutch Society of Obstetrics and Gynaecology.
Main outcome measures Incidence, clinical features and risk factors.
Results Fifteen maternal deaths occurred due to meningitis, representing 4.4% of all maternal deaths. Twelve women (80%) presented with meningitis during pregnancy, 8 (66%) of them in the third trimester. Presenting symptoms were altered mental status (11; 73%), fever (9; 60%), nuchal rigidity (5; 33%) and headache (13; 87%). Nine women (60%) had otolaryngological infection at presentation or in the previous days or weeks. Twelve women (80%) underwent radiological examination, of which 5 (33%) showed distinct abnormalities. Cerebrospinal fluid (CSF) examination showed infected CSF in 8 (53%) women. In ten women (67%) Streptococcus pneumoniae was isolated. Substandard care was identified in 4 (27%) women.
Conclusion Pregnant or puerperal women presenting with classical symptoms of meningitis, particularly those with a history of otolaryngological infection or headache, should undergo thorough investigation and radiological and CSF examinations. Early diagnosis and immediate antibiotic treatment are imperative because of rapid deterioration in pregnant women. In case of doubt, the threshold for antibiotic treatment should be low and close monitoring is warranted.
Objective
To compare incidences, characteristics, management and outcome of eclampsia in the
N
etherlands and the
UK
.
Design
A comparative analysis of two population‐based prospective cohort ...studies.
Setting
All hospitals with consultant‐led maternity units.
Population
Women with eclampsia in the
N
etherlands (226) and the
UK
(264).
Methods
Comparison of individual level data from national studies in the
N
etherlands and the
UK
(
LEMM
oN 2004–06;
UKOSS
2005/06).
Main outcome measures
Incidence, maternal complications and differences in management strategies.
Results
Incidences of eclampsia differed significantly between both countries: the
N
etherlands 5.4/10 000 deliveries versus
UK
2.7/10 000 (relative risk
RR
1.94, 95% confidence intervals 95%
CI
1.6–2.4). The proportion of women with a preceding diagnosis of pre‐eclampsia was comparable between both countries (the
N
etherlands 42%;
UK
43%), as was the proportion who received magnesium sulphate prophylaxis. Women in the
N
etherlands had a significantly higher maximum diastolic blood pressure (111 mmHg versus 95 mmHg,
P
< 0.001); significantly fewer received anti‐hypertensive medication (16% versus 71%;
RR
0.2, 95%
CI
0.1–0.3) and were treated less often with magnesium sulphate after their first fit (95% versus 99%;
RR
0.96, 95%
CI
0.92–0.99). Maternal death occurred in three cases in the
N
etherlands compared with zero in the
UK
.
Conclusions
The incidence of eclampsia in the
N
etherlands was twice as high compared with the
UK
when using uniform definitions. Women with eclampsia in the
N
etherlands were not managed according to guidelines, particularly with respect to blood pressure management. Changes in management practice may reduce both incidence and poor outcomes.
Summary
background Although radioiodine therapy in differentiated thyroid carcinoma without radioiodine accumulation has not been considered harmful, increased thyrotrophin levels during thyroxine ...withdrawal without the benefit of radiotoxicity as well as the selection of de‐differentiated cells may have disadvantageous effects on tumour course.
objective We therefore analysed retrospectively the effects of radioiodine therapy on the course of serum thyroglobulin levels as a tumour marker in patients with progressive residual or metastatic differentiated thyroid carcinoma, with or without radioiodine accumulation on post‐therapeutic whole body scintigraphy.
patients and methods Patients who had undergone radioiodine therapies with sufficient pre‐ and post‐therapy thyroglobulin measurements to allow for regression analysis and not preceded or followed by other treatment modalities within a 1‐year interval were selected. All patients had undergone total thyroidectomy and ablative therapy. Thirty‐nine patients and radioiodine therapies were included (10 males, 29 females, mean age 57 years), and divided into a negative‐ (n = 17) and a positive post‐therapeutic whole body scintigraphy group (n = 22). Pre‐ and post‐therapeutic thyroglobulin course were analysed using non‐linear regression, comparing the difference in the thyroglobulin growth coefficient b1 post‐ and pre‐therapy (delta b1: b1post‐therapy‐b1pre‐therapy). In addition, absolute post‐ and pre‐therapeutic thyroglobulin levels, radiological follow‐up and clinical outcome were also analysed.
results The two groups were comparable with respect to age, sex, tumour stage, histology and prior therapies. Differences between post‐ and pre‐therapeutic b1 values differed significantly in the positive post‐therapeutic whole body scintigraphy group (delta b1: –0·65 µg/l−1 years−1, P < 0·001) but not in the negative post‐therapeutic whole body scintigraphy group (delta b1: –0·14). Absolute serum thyroglobulin levels and radiological follow‐up revealed a favourable response of radioiodine therapy in the positive whole body scintigraphy group but not in the negative group. Delta b1 was related significantly with clinical outcome as revealed by receiver operator curves (ROC): all patients with a positive delta b1 (n = 8) had an unfavourable outcome (progression or death), whereas from the 31 patients with negative delta b1, 61% had an unfavourable outcome.
conclusion We did not find disadvantageous effects of a single radioiodine therapy on serum thyroglobulin increments in patients with negative post‐therapeutic whole body scintigraphy. However, as we did not observe a beneficial effect either, we would not advise the continuation of radioiodine therapy in patients with negative post‐therapeutic whole‐body scintigraphy, unless a positive response is observed in individual cases.
PDF
