C.J.M. de Groot

On the presence of organic phosphate in some Camargue sediments : evidence for the importance of phytate

The organic phosphate pool of some Camargue sediments (South of France) was studied, after removal of inorganic phosphate, with Ca-NTA/dithionite (Fe bound phosphate) and Na-EDTA (Ca bound phosphate). The organic phosphate was divided into an acid soluble organic phosphate fraction (ASOP) and a residual organic phosphate fraction (ROP). The extraction of organic matter with 2.0 M NaOH (90 °C) from ROP yielded considerable quantities of Org-P. In this extract the presence of phytate (inositol hexa phosphate) could be demonstrated using phytase to hydrolyse the phytate. Phytate was shown to account for a considerable part of organic phosphate in sediments of freshwater marsh sediments as well as in the sediment of the brackish/salt water lake ‘Etang de Vaccares’. In laboratory experiments phytate was found to precipitate with all poly-valent cations tested. Furthermore, phytate was found to be strongly adsorbed onto Fe(OOH), which may explain its accumulation and its stability in sediments.Considerable quantities of ASOP were found; the chemical stucture of this pool remains unknown.

The time of separation of the umbilical cord

The time of separation of the umbilical cord was studied in 911 neonates. The mean time of separation was 7.4 days (SD 3.3, range 1–29 days). We sought a possible relationship between the time of cord separation and various factors in the perinatal period. Cord separation was delayed when antibiotics needed to be administered to the neonate because of sepsis, when the infant was born prematurely, delivered by Caesarean section or had a low birth weight. The cord separated slightly earlier in female than in male infants. None of the infannts studied suffered from omphalitis and it would appear that “delayed” separation of the cord is not always necessarily accompanied by severe leucocyte dysfunction.

Prenatal detection of transposition of the great arteries reduces mortality and morbidity

To evaluate the prenatal detection of transposition of the great arteries (TGA), after the introduction of a Dutch screening program in 2007, as well as the effect of prenatal detection on pre‐ and postsurgical mortality and morbidity.

Intra-uterine demonstration of bowel duplication by ultrasound

In this case report a patient is presented, showing large sonolucent areas inside the fetal abdomen at 20 wk of gestation. Gastrointestinal (GI) tract obstruction was suspected. There was no polyhydramnios. After premature delivery the child showed marked abdominal distention, but stayed in good condition without signs of GI tract obstruction. At laparotomy, a 30 cm long, distended duplication of the terminal ileum was removed. Postoperative course was uneventful.

Association between weight gain during pregnancy and pregnancy outcomes after dietary and lifestyle interventions: a meta-analysis

OBJECTIVES Lifestyle interventions in obese pregnant women reduce adverse maternal outcomes of pregnancy. However, the association between weight change due to interventions and the actual reduction in complications is unknown. The objective of this study was to determine the association between gestational weight gain (GWG) and the rate of pregnancy complications. STUDY DESIGN The authors included randomized controlled trials (RCTs) assessing the effect of lifestyle interventions during pregnancy on GWG and adverse maternal and fetal outcomes. For each outcome they assessed the association between GWG and the risk of adverse pregnancy outcomes. RESULTS They analyzed data of 23 RCTs (4,990 women). Increased GWG was associated with a nonsignificant increase in the incidence of preeclampsia (PE) (0.2% per gained kg, 95% confidence interval [CI] 0.5 to 0.9%, p > 0.05), gestational diabetes (GDM) (0.3% per gained kg, 95% CI -0.5 to 1.0%, p > 0.05), and induction of labor (IOL) (1.5% per gained kg, 95% CI -0.9 to 3.9%, p > 0.05). CONCLUSIONS Reduction in GWG due to lifestyle interventions in pregnancy had statistically nonsignificant effects on lowering the incidence of PE, GDM, and IOL. Possibly, the beneficial effect of lifestyle interventions on pregnancy outcomes is due to an effect independent of the reduction of GWG.

Prenatal diagnosis of congenital heart defects: accuracy and discrepancies in a multicenter cohort

To examine the accuracy of fetal echocardiography in diagnosing congenital heart disease (CHD) at the fetal medicine units of three tertiary care centers.

Prognostic accuracy of cerebroplacental ratio and middle cerebral artery Doppler for adverse perinatal outcome: systematic review and meta‐analysis

Doppler ultrasonographic assessment of the cerebroplacental ratio (CPR) and middle cerebral artery (MCA) is widely used as an adjunct to umbilical artery (UA) Doppler to identify fetuses at risk of adverse perinatal outcome. However, reported estimates of its accuracy vary considerably. The aim of this study was to review systematically the prognostic accuracies of CPR and MCA Doppler in predicting adverse perinatal outcome, and to compare these with UA Doppler, in order to identify whether CPR and MCA Doppler evaluation are of added value to UA Doppler.

Is cervical length associated with maternal characteristics

OBJECTIVE Women with a mid-trimester short cervical length (CL) are at increased risk for preterm delivery. Consequently, CL measurement is a potential screening tool to identify women at risk for preterm birth. Our objective was to assess possible associations between CL and maternal characteristics. STUDY DESIGN A nationwide screening study was performed in which CL was measured during the standard anomaly scan among low risk women with a singleton pregnancy. Data on maternal height, pre-pregnancy weight, ethnicity, parity and gestational age at the time of the CL measurement were collected from January 2010 to December 2012. Univariable and multivariable linear regression analyses were performed to assess the relationship between CL and maternal characteristics. RESULTS We included 5092 women. The mean CL was 44.3mm. No association was found between CL and maternal height or gestational age of the measurement. Maternal weight was associated with CL (p=0.007, adjusted R(2) 0.03). Separate analysis for BMI did not change these results. Ethnicity, known in 2702 out of 5092 women, was associated with CL (mean CL in Caucasian women 45.0mm, Asian 43.9mm, Mediterranean 43.1mm, and African 41.8mm, p=0.003), as well as parity (mean CL multiparous 45.3mm, nulliparous 43.5mm, p<0.0001). CONCLUSION Shorter mid-trimester cervical length is associated with higher maternal weight, younger maternal age, nulliparity and non-Caucasian ethnicity, but not with maternal height.

Using vaginal Group B Streptococcus colonisation in women with preterm premature rupture of membranes to guide the decision for immediate delivery: a secondary analysis of the PPROMEXIL trials

To investigate whether vaginal Group B Streptococcus (GBS) colonisation or other baseline characteristics of women with preterm premature rupture of membranes (PPROM) can help in identifying subgroups of women who would benefit from immediate delivery.

Termination of pregnancy for maternal indications at the limits of fetal viability: a retrospective cohort study in the Dutch tertiary care centres

Objective Maternal morbidity, either pregnancy related or pre-existent, can become life threatening and of such severity as to warrant termination of pregnancy (TOP). In this situation, chances of fetal survival are usually poor, either because of low gestational age and/or because of the fetal effects of the maternal condition. Examples include severe growth restriction in pre-eclampsia and intrauterine infection due to the very early preterm prelabour rupture of membranes. There are very few reports on the prevalence of TOP for maternal indication at the limits of fetal viability. We investigated the prevalence of and indications for TOP on maternal indication in the 10 tertiary care centres in the Netherlands during the past decade. Study design We conducted a retrospective review of the medical records of all women who underwent TOP for maternal indications between 22 and 27 completed weeks of gestation in all 10 tertiary care centres from 2000 to 2009. Results During the study period, there were 1 929 470 deliveries; 163 052 (8.4%) of these took place in one of the 10 tertiary care centres and 177 pregnancies were terminated for severe maternal disease, 131 for hypertensive disorders, 29 for intrauterine infection and 17 for other reasons. The mean gestational age at TOP was 171 days (243/7)±10 days. No maternal deaths were recorded. The overall perinatal mortality was 99.4%. Conclusions Over a 10-year period, TOP for maternal indications was performed in 1 in 1000 deliveries in the 10 Dutch tertiary care centres. Hypertensive disorders comprised three-quarters of the cases.