Summary
Anaphylaxis in pregnancy is a rare but severe complication for both mother and infant. Population‐based data on anaphylaxis in pregnancy are lacking from mainland European countries. This ...multinational study presents the incidence, causative agents, management and maternal and infant outcomes of anaphylaxis in pregnancy. This descriptive multinational study used a combination of retrospective (Finnish medical registries) and prospective population‐based studies (UK, France, Belgium and the Netherlands) to identify cases of anaphylaxis. Sixty‐five cases were identified among 4,446,120 maternities (1.5 per 100,000 maternities; 95%CI 1.1–1.9). The incidence did not vary between countries. Approximately three‐quarters of reactions occurred at the time of delivery. The most common causes were antibiotics in 27 women (43%), and anaesthetic agents in 11 women (17%; including neuromuscular blocking drugs, 7), which varied between countries. Anaphylaxis had very poor outcomes for one in seven mothers and one in seven babies; the maternal case fatality rate was 3.2% (95%CI 0.4–11.0) and the neonatal encephalopathy rate was 14.3% (95%CI 4.8–30.3). Across Europe, anaphylaxis related to pregnancy is rare despite having a multitude of causative agents and different antibiotic prophylaxis protocols.
ObjectivesWe aimed to assess the prevalence of uterine rupture in Belgium and to evaluate risk factors, management and outcomes for mother and child.DesignNationwide population-based prospective ...cohort study.SettingEmergency obstetric care. Participation of 97% of maternity units covering 98.6% of the deliveries in Belgium.ParticipantsAll women with uterine rupture in Belgium between January 2012 and December 2013. 8 women were excluded because data collection forms were not returned.ResultsData on 90 cases of confirmed uterine rupture were obtained, of which 73 had a previous Caesarean section (CS), representing an estimated prevalence of 3.6 (95% CI 2.9 to 4.4) per 10 000 deliveries overall and of 27 (95% CI 21 to 33) and 0.7 (95% CI 0.4 to 1.2) per 10 000 deliveries in women with and without previous CS, respectively. Rupture occurred during trial of labour after caesarean section (TOLAC) in 57 women (81.4%, 95% CI 68% to 88%), with a high rate of augmented (38.5%) and induced (29.8%) labour. All patients who underwent induction of labour had an unfavourable cervix at start of induction (Bishop Score ≤7 in 100%). Other uterine surgery was reported in the history of 22 cases (24%, 95% CI 17% to 34%), including 1 case of myomectomy, 3 cases of salpingectomy and 2 cases of hysteroscopic resection of a uterine septum. 14 cases ruptured in the absence of labour (15.6%, 95% CI 9.5% to 24.7%). No mothers died; 8 required hysterectomy (8.9%, 95% CI 4.6% to 16.6%). There were 10 perinatal deaths (perinatal mortality rate 117/1000 births, 95% CI 60 to 203) and perinatal asphyxia was observed in 29 infants (34.5%, 95% CI 25.2% to 45.1%).ConclusionsThe prevalence of uterine rupture in Belgium is similar to that in other Western countries. There is scope for improvement through the implementation of nationally adopted guidelines on TOLAC, to prevent use of unsafe procedures, and thereby reduce avoidable morbidity and mortality.
Purpose: This research aimed to integrate three previously developed assistive technology (AT) systems into one modular, multifunctional system, which can support people with dementia and carers ...throughout the course of dementia. . In an explorative evaluation study, the integrated system, called Rosetta, was tested on usefulness, user-friendliness and impact, in people with dementia, their informal carers and professional carers involved. The Rosetta system was installed in participants' homes in three countries: The Netherlands, Germany and Belgium. Methods: Controlled trial with pre- and post-test measures across three countries (randomized controlled trial in Germany; matched groups in the Netherlands and Belgium). Participants completed questionnaires for impact measurement and participated in semi-structured interviews regarding usefulness and user-friendliness of Rosetta. Results: All participants agreed that Rosetta is a very useful development. They did not rate the user-friendliness of the system highly. No significant effects were found on impact measurements. Conclusion: All participants found Rosetta a very useful development for future care, and would consider using it. Since Rosetta was still in development during evaluation, a discrepancy between expectations and actual functioning of Rosetta existed, which may explain the lack of findings on the impact of the system and the low appreciation of user-friendliness.
Implications for Rehabilitation
People with dementia and carers find assistive technology (AT) a useful future development and they are willing to use it in the future.
People with dementia and carers have little privacy issues with AT. If they have concerns, they are willing to accept the trade-off of reduced privacy in exchange for the ability to live in their own homes for longer.
Given that a system works flawlessly, informal carers indicate that integrated AT can reduce their burden and stress. This can in turn help informal carers to provide better care for a longer period of time.
Cette étude a utilisé l'analyse de clusters, qui est une technique exploratoire pour classer les individus dans des groupes semblables en fonction de l'ensemble des variables identifiées. L'objectif ...est d'identifier des profils de mères avec des caractéristiques similaires aux niveaux biomédical et sociodémographique et d'étudier la répartition de l'âge maternel par clusters. Cette étude est fondée sur les certificats de naissance dans deux régions belges et a inclus les grossesses uniques issues du mois de décembre 2014. L'analyse de correspondance multiple suivie d'une classification hiérarchique ascendante a été menée. Trois clusters ont été identifiés. Les caractéristiques biomédicales et sociodémographiques ainsi que la distribution de l'âge maternel diffèrent de manière significative entre les clusters.
L'objectif est de développer des courbes de croissance ajustées sur des facteurs maternels et fœtaux dans deux régions belges (Wallonie et Bruxelles) afin de créer un indicateur « petit poids pour ...âge gestationnel » (PAG). Trois indicateurs PAG ont été créés sur la base de modèles de croissance in utero, développés par Gardosi : non ajusté (modèle 1), tenant compte du sexe (modèle 2) et ajusté sur les facteurs maternels (taille et poids de la mère, parité) et fœtaux (modèle 3). Parmi les naissances, la proportion d'enfants avec un petit poids pour leur âge gestationnel (AG) est de 8,1 % avec le modèle 1, 7,9 % avec le modèle 2 et 6,8 % avec le modèle 3. Le modèle 3 reclasse 2,6 % des naissances. L'indicateur PAG, prenant en considération les facteurs maternels et fœtaux, est une première en Belgique. La proportion d'enfants avec un petit poids pour leur AG diminue lorsque les facteurs maternels et fœtaux sont pris en compte.
In 2011 the Belgian Obstetric Surveillance System (B.OSS) was set up to monitor severe maternal morbidity in Belgium.
The aim of B.OSS is to get an accurate picture of the obstetric complications ...under investigation and secondly, to improve the quality and safety of obstetric care in Belgium by practical recommendations based on the results.
Data are obtained through prospective active collection of cases by a monthly call according to the principle of nothing-to-report, along with data collection forms that confirm the diagnosis and gather detailed information. Data-collection occurs web-based since August 2013 through www.b-oss.be.
B.OSS achieves excellent participation rates and response rates. The results of the first registration round are gradually brought out by means of scientific publications and presentations, biennial reports, newsletters and the website. The international comparison of results within the International Network of Obstetric Survey Systems (INOSS) gives important added value. No alternative mandatory data sources are appropriate to check for underreporting.
B.OSS is successful in monitoring severe maternal morbidity thanks to the willingness of the Belgian OB-GYNs. The results of the first studies suggest the need to develop nationally adopted guidelines. Furthermore, the results invite to critically evaluate the current organisation of obstetric health care in Belgium. B.OSS aims to monitor the impact on patient safety in future surveys, when guidelines and recommendations are put into practice.
The pharmacokinetics of intravenous and oral tacrolimus was assessed in paediatric liver transplant patients at two centers in Europe. Sixteen patients, age 0.7 to 13 years, participated in the ...study; 12 patients were evaluable for intravenous pharmacokinetics, and 16 for oral. Intravenous tacrolimus was given as a continuous 24 h infusion (mean 0.037+/-0.013 mg/kg/day), and oral tacrolimus was given in 2 doses per day (mean 0.152+/-0.015 mg/kg). Whole blood samples for the intravenous pharmacokinetic profile were taken before initiation of the first infusion, 4, 8, 12 and 24 h post-infusion, and every 24 h thereafter until intravenous administration was discontinued. During the 12 h wash-out period between intravenous and oral administration, samples were taken every 3 h. Samples for the oral pharmacokinetic profile were taken immediately before the first oral dose and 0.5, 0.75, 1, 2, 2.5, 3, 4, 6, 8, 10 and 12 h post-administration. Non-compartmental procedures were used to characterise the pharmacokinetic parameters. Mean estimates for clearance and terminal half-life were 2.3+/-1.2 ml/min/kg and 11.5+/-3.8 h, respectively, following intravenous tacrolimus. The mean bioavailability of oral tacrolimus was 25+/-20%. A strong correlation was observed between AUC and trough whole blood levels of tacrolimus (r=0.90). The clearance was approximately 2-fold higher than that previously observed in adults; this could explain the higher dosage requirements in children.
PDF
