Gustaaf A. Dekker

Third degree obstetric perineal tears: risk factors and the preventive role of mediolateral episiotomy

Objective To determine risk factors for third degree obstetric perineal tears and to give recommendations for prevention.

Application of a customised birthweight standard in the assessment of perinatal outcome in a high risk population

Objective Physiological as well as pathological variables influence birthweight. The aim of the present study was to examine perinatal outcome in relation to birthweight centiles applying a customised birthweight standard.

Psychosocial factors as predictors of maternal well-being and pregnancy-related complaints.

The aim of the current study was to investigate the effects of psychosocial variables on well-being and on pregnancy-related complaints throughout pregnancy. Three hundred and ninety-six nulliparous women completed questionnaires on number of daily stressors, social support, gestational factors and mental and physical work load in each trimester of pregnancy. In addition, the following dependent measures were assessed: depression, anxiety, somatic complaints, and the pregnancy-related complaints fatigue, nausea and back pain. The independent variables predicted depression best (r2 = 42-44%), followed by anxiety (R2 = 13-20) and somatic complaints (R2 = 16-21%). Number of daily stressors explained most of the variance. Satisfaction with social support and maternal age were negatively correlated with depression. In contrast, pregnancy-related complaints could be less accurately predicted by psychosocial factors. The amount of explained variance for fatigue ranged between 6 and 10%, for nausea between 2 and 6%, and for back pain between 5 and 7% for the three trimesters. It is concluded that depressive symptoms during pregnancy are associated with negative psychosocial factors, particularly the number of daily stressors and low satisfaction with received social support. To a lesser degree, this is also the case with anxiety and somatic complaints. Pregnancy-related complaints, on the other hand, appear to be relatively independent of psychosocial conditions.

Failure to detect linkage of preeclampsia to the region of the NOS3 locus on chromosome 7q.

Generous support for this work was provided by a project grant and Ph.D. studentship (to I.L.) from the British Heart Foundation.

Loop electrosurgical excision procedure of the cervix and time of delivery in subsequent pregnancy

Objective: To study the effect of the loop electrosurgical excision procedure (LEEP) on gestational age at delivery in the subsequent pregnancy. Method: Identification of women with LEEP. Chart analysis and inquiry into gestational age at the subsequent delivery. Exclusion of first trimester abortions, multiple gestations, cold knife conizations and women over 40 years during LEEP. For comparison, 40 weeks was used as the mean date of delivery in a normal population. Wilcoxon signed rank test was used and P<0.05 was considered significant. Result: Fifty‐six women delivered after LEEP. Seven delivered preterm of whom three were induced and one had a history of preterm delivery. Deliveries prior to 32 weeks of gestation did not occur. Mean gestational age at delivery was 39 2/7 weeks (95%CI: 38 5/7–39 6/7) which is significantly earlier (P=0.03) than the hypothetical 40 weeks. Conclusion: After LEEP, deliveries prior to 32 weeks did not occur. Gestational age at delivery was only 5 days earlier than expected. LEEP cannot be considered a risk for early preterm delivery.

Maternal and fetal plasma concentrations of endothelin, lipidhydroperoxides, glutathione peroxidase and fibronectin in relation to abnormal umbilical artery velocimetry

OBJECTIVE To study plasma concentrations of endothelin (ET), lipidhydroperoxides (LOOH), glutathione peroxidase (GSHpx) and fibronectin in relation to abnormal umbilical artery velocimetry. STUDY DESIGN Plasma concentrations of ET, LOOH, GSHpx and fibronectin were measured in fetal and maternal venous blood in: (i) a control group (n=10); (ii) in pregnancies complicated by intrauterine growth retardation (IUGR) (n=6) or preeclampsia (n=5) with positive end diastolic flow; and in (iii) pregnancies complicated by absent or reversed end diastolic (ARED) flow in the umbilical artery (n=18). All children were delivered by primary caesarean section. RESULTS The significantly highest maternal and fetal ET concentrations were found in plasma collected in pregnancies complicated by ARED flow in the umbilical artery. Maternal fibronectin levels were significantly raised in the ARED flow group. Maternal plasma ET levels were lowest in pregnancies complicated by IUGR. The maternal and fetal plasma concentrations of LOOH and GSHpx did not differ significantly between the groups. CONCLUSION Abnormal Doppler velocimetry, especially ARED flow is associated with elevated maternal and fetal plasma levels of ET. The exact mechanism causing the placental vasoconstriction is unknown yet, but oxidative stress seems not to be involved.

Smoking status in pregnancy is associated with daily stressors and low well-being

Abstract Cigarette smoking in pregnancy is one of the main, avoidable hazards for fetal health. The present study was designed to investigate in pregnant nulliparous women the relationship between smoking behaviour and self-reported daily stressors, as well as psychological and somatic well-being. A sample of 396 eligible participants was studied in a prospective design. Questionnaires on psychosocial factors were completed in each trimester of pregnancy. Smoking behaviour was categorised as follows: (1) Never Smokers (n = 235), (2) Former Smokers (n = 60) and (3) Current Smokers (n = 101), subdivided in Continued Smokers (n = 67) and Relapsers (n = 21), while 13 were not assigned to either group because of fluctuating smoking behaviour. Multivariate analysis revealed that Former Smokers and Current Smokers repotted significantly more daily stressors than Never Smokers (p < 0.0001) and rated these as more severe (p < 0.0001). Current Smokers expressed significantly more depressive (p < 0.0001), anxious (p...