H.C. Scheepers

Transfusion policy after severe postpartum haemorrhage: a randomised non-inferiority trial

To assess the effect of red blood cell (RBC) transfusion on quality of life in acutely anaemic women after postpartum haemorrhage.

Should cervical favourability play a role in the decision for labour induction in gestational hypertension or mild pre-eclampsia at term? An exploratory analysis of the HYPITAT trial

Please cite this paper as: Tajik P, van der Tuuk K, Koopmans C, Groen H, van Pampus M, van der Berg P, van der Post J, van Loon A, de Groot C, Kwee A, Huisjes A, van Beek E, Papatsonis D, Bloemenkamp K, van Unnik G, Porath M, Rijnders R, Stigter R, de Boer K, Scheepers H, Zwinderman A, Bossuyt P, Mol B. Should cervical favourability play a role in the decision for labour induction in gestational hypertension or mild pre‐eclampsia at term? An exploratory analysis of the HYPITAT trial. BJOG 2012;119:1123–1130.

Predicting successful vaginal birth after Cesarean section using a model based on Cesarean scar features examined by transvaginal sonography

Several models that estimate the probability of successful vaginal birth after Cesarean section (VBAC) have been published and many achieve reasonable predictive performance in terms of discrimination and calibration1. Naji et al.2 presented an innovative and interesting prediction model by introducing novel predictors derived from sonographic measurement of the Cesarean scar. This model was developed within a cohort of just 131 women with one previous Cesarean section. The final model consists of four variables: maternal age, prior VBAC, residual myometrial thickness (RMT) and change in RMT from the first to the second trimester. It is notable that the presented model has extraordinary results regarding discriminative performance, with an area under the receiver–operating characteristics curve (AUC) of 0.94, close to the theoretical maximum of 1. These positive results can be attributed to the introduction of the Cesarean scar variables, since their addition leads to a remarkable improvement in the AUC from 0.62 to 0.94. However, the introduction of Cesarean scar variables deserves further attention. The association of these variables with the probability of successful trial of VBAC was reported by Naji et al. in an earlier study using the same data3. There is no plausible mechanism that explains why these variables have such an impact on the probability of success. Furthermore, rather than choosing predictors based on observed significant relations to outcome variables in the same dataset, contemporary methodological guidelines for prediction research state that predictors should be chosen based on preselection4, a method that results in higher external validity and less overfitting. Therefore, we would like to emphasize the importance of external validation of these predictors in other data. Additionally, the need for external validation is shown when looking into studies on interand intraobserver validity of the RMT measurements. These studies use cut-off values of 2.4–3.5 mm for evaluating reproducibility and state that overall interobserver differences are ≤ 1 mm for 77.5–88% of observers5,6. However, in the model RMT is entered in millimeters while predicted probability increases per millimeter with a coefficient (beta) of 1.44. Therefore, a variability of 1 mm between measurements compromises the model’s performance. To be more explicit, the 32-year-old patient without a previous VBAC, with an RMT of 2.7 mm and an RMT decrease of 1.5 mm, has a predicted probability of successful trial of VBAC of 36%; however, if 3.7 mm instead of 2.7 mm had been measured for the RMT, the predicted probability would have increased to 71%.

Involving women in personalised decision-making on mode of delivery after caesarean section: the development and pilot testing of a patient decision aid

To develop a patient decision aid (PtDA) for mode of delivery after caesarean section that integrates personalised prediction of vaginal birth after caesarean (VBAC) with the elicitation of patient preferences and evidence‐based information.

Routine labour epidural analgesia versus labour analgesia on request: a randomised non‐inferiority trial

To assess the effect on mode of delivery of the routine use of labour epidural analgesia (EA) compared with analgesia on request.

An economic analysis of immediate delivery and expectant monitoring in women with hypertensive disorders of pregnancy, between 34 and 37 weeks of gestation (HYPITAT-II)

To assess the economic consequences of immediate delivery compared with expectant monitoring in women with preterm non‐severe hypertensive disorders of pregnancy.

What Makes for Good Collaboration and Communication in Maternity Care? A Scoping Study

BACKGROUND: Good communication and collaboration are critical to safe care for mothers and babies. OBJECTIVE: To identify factors associated with good collaboration and communication among maternity care professionals and between both professionals and parents. METHOD: Scoping study. We searched PubMed and Web of Science for peer reviewed, quantitative and qualitative, original, primary research in Western societies on communication and collaboration in maternity care among professionals (Search 1) and between professionals and parents (Search 2). FINDINGS: The 40 studies (14 in Search 1; 26 in Search 2) that met our selection criteria highlighted several factors associated with good communication and collaboration. We grouped these factors into 6 categories: Expertise, Partnership, Context, Attitude, Trust, and Communication style. Studies of communication and collaboration among professionals foregrounded work-related aspects, whereas studies examining collaboration between professionals and parents paid more attention to interpersonal aspects. Before 2012, few studies covered positive aspects of communication and collaboration. We also found an underrepresentation of parents in study populations. CONCLUSION: Our study is part of a growing trend of identifying the positive aspects of communication and collaboration in maternity care. As the study of collaboration in practice continues, researchers need to be sure to involve all stakeholders, including parents.

Prenatal (non)treatment decisions in extreme prematurity: evaluation of Decisional Conflict and Regret among parents

Objective:To evaluate Decisional Conflict and Regret among parents regarding the decision on initiating comfort or active care in extreme prematurity and to relate these to decision-making characteristics.Study Design:A nationwide, multicenter, cross-sectional study using an online survey in the Netherlands. Data were collected from March 2015 to March 2016 among all parents with infants born at 24+0/7–24+6/7 weeks gestational age in 2010–2013. The survey contained a Decisional Conflict and Decision Regret Scale (potential scores range from 0 to 100) and decision-making characteristics.Results:Sixty-one surveys were returned (response rate 27%). The median Decisional Conflict score was 28. From the subscores within Decisional Conflict, ‘values clarity’ revealed the highest median score of 42—revealing that parents felt unclear about personal values for benefits and risks of the decision on either comfort care or active care. The median Decision Regret score was 0. Regret scores were influenced by the actual decision made and by outcome: Decision Regret was lower in the active care group and in the survivor group.Conclusion:We found little Decisional Conflict and no Decision Regret among parents regarding decision-making at 24 weeks gestation.

Maternal and neonatal outcomes in women with severe early onset pre-eclampsia before 26 weeks of gestation, a case series.

To describe the maternal and neonatal outcomes and prolongation of pregnancies with severe early onset pre‐eclampsia before 26 weeks of gestation.

Multicenter impact analysis of a model for predicting recurrent early-onset preeclampsia: A before–after study

ABSTRACT Objective: This study aims to determine the impact of using a prediction model for recurrent preeclampsia to customize antenatal care in subsequent pregnancies. Methods: We compared care consumption, pregnancy outcomes, and self-reported health state of two risk-based subgroups, and compared these to a reference group receiving standard care. Results: We included a total of 311 women from 12 hospitals. Compared to standard care, recurrence-risk guided care did not lead to different outcomes or self-perceived health. Conclusion: Our study exemplifies that recurrence-risk-based stratification of antenatal care in former preeclampsia patients is feasible; it does not lead to worse pregnancy outcomes.