Wim C J Hop

Erasmus MC, Rotterdam, South Holland, Netherlands

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Publications (872)3864.92 Total impact

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    ABSTRACT: The aim of this study was to assess the effect of intravenous (IV) insulin administration in children with severe acute asthma (SAA) and hyperglycemia on IV salbutamol consumption and length of stay (LOS) in a pediatric intensive care unit (PICU). Retrospective, descriptive study of the clinical course before and after implementation of an insulin protocol for the treatment of hyperglycemia (i.e. blood glucose >8 mmol/L or 144 mg/dL, respectively) in the PICU of a tertiary care university hospital. Admissions between 1994 and 2010 were reviewed. The insulin protocol was introduced in 2006. A total of 131 pediatric patients with SAA complicated by hyperglycemia requiring IV salbutamol were included. Severity of illness before and after implementation of the insulin protocol did not significantly differ. The insulin-treated patient group had significantly higher maximum blood glucose levels and higher cumulative IV salbutamol dose than the non-treated group. There were no differences between these groups in the duration of IV salbutamol administration and LOS. In view of the lack of difference in outcomes and considering that the insulin protocol is labor-intensive, the question is whether this protocol is efficacious for the treatment of pediatric SAA associated with hyperglycemia.
    Journal of Asthma 05/2015; DOI:10.3109/02770903.2015.1008139 · 1.83 Impact Factor
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    ABSTRACT: Asthma guidelines recommend monitoring of asthma control. However, in a substantial proportion of children, asthma is poorly controlled and the best monitoring strategy is not known. We studied two monitoring strategies for their ability to improve asthma outcomes in comparison with standard care (SC): web-based monthly monitoring with the (Childhood) Asthma Control Test (ACT or C-ACT) and 4-monthly monitoring of FENO. In this randomised controlled, partly blinded, parallel group multicentre trial with a 1-year follow-up, children aged 4-18 years with a doctor's diagnosis of asthma treated in seven hospitals were randomised to one of the three groups. In the web group, treatment was adapted according to ACT obtained via a website at 1-month intervals; in the FENO group according to ACT and FENO, and in the SC group according to the ACT at 4-monthly visits. The primary endpoint was the change from baseline in the proportion of symptom-free days (SFD). Two-hundred and eighty children (mean age 10.4 years, 66% boys) were included; 268 completed the study. Mean changes from baseline in SFD were similar between the groups: -2.1% (web group, n=90), +8.9% (FENO group, n=91) versus 0.15% (SC, n=87), p=0.15 and p=0.78. Daily dose of inhaled corticosteroids (ICS) decreased more in the web-based group compared with both other groups (-200 μg/day, p<0.01), while ACT and SFD remained similar. The change from baseline in SFD did not differ between monitoring strategies. With web-based ACT monitoring, ICS could be reduced substantially while control was maintained. NTR 1995. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
    Thorax 03/2015; 70(6). DOI:10.1136/thoraxjnl-2014-206161 · 8.56 Impact Factor
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    ABSTRACT: To investigate changes in trapped air volume and distribution over time and compare computed tomography (CT) with pulmonary function tests for determining trapped air. Thirty children contributed two CTs and pulmonary function tests over 2 years. Localized changes in trapped air on CT were assessed using image analysis software, by deforming the CT at timepoint 2 to match timepoint 1, and measuring the volume of stable (TAstable), disappeared (TAdisappeared) and new (TAnew) trapped air as a proportion of total lung volume. We used the difference between total lung capacity measured by plethysmography and helium dilution, residual volume to total lung capacity ratio, forced expiratory flow at 75% of vital capacity, and maximum mid-expiratory flow as pulmonary function test markers of trapped air. Statistical analysis included Wilcoxon's signed rank test and Spearman correlation coefficients. Median (range) age at baseline was 11.9 (5-17) years. Median (range) of trapped air was 9.5 (2-33)% at timepoint 1 and 9.0 (0-25)% at timepoint 2 (p=0.49). Median (range) TAstable, TAdisappeared and TAnew were respectively 3.0 (0-12)%, 5.0 (1-22)% and 7.0 (0-20)%. Trapped air on CT correlated statistically significantly with all pulmonary function measures (p<0.01), other than residual volume to total lung capacity ratio (p=0.37). Trapped air on CT did not significantly progress over 2 years, may have a substantial stable component, and is significantly correlated with pulmonary function markers. Copyright © 2015. Published by Elsevier Ireland Ltd.
    European Journal of Radiology 02/2015; 84(6). DOI:10.1016/j.ejrad.2015.02.011 · 2.16 Impact Factor
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    ABSTRACT: We prospectively studied the incidence and clinical course of hypertriglyceridemia and hypercholesterolemia during very prolonged use of asparaginase or in relation to asparaginase activity levels in children with acute lymphoblastic leukemia. Also, incidence of pancreatitis, thrombosis, hyperammonemia and central neurotoxicity and their association with asparaginase activity levels were evaluated. 89 patients were treated according to Dutch Childhood Oncology Group Acute Lymphoblastic Leukemia 10 medium-risk intensification protocol, which includes 15 doses PEGasparaginase(2,500 IU/m2) for 30 weeks. Erwinia-asparaginase(20,000 IU/m2) was administered when allergy to or silent inactivation of PEGasparaginase occurred. Triglyceride/cholesterol/ammonia levels increased rapidly in children with PEGasparaginase and remained temporary elevated, but normalized after finishing the last asparaginase dose. Hypertriglyceridemia and hypercholesterolemia(grade 3/4) were found in 47% and in 25%, respectively, of PEGasparaginase-treated patients. Studying the correlations between PEGasparaginase activity levels and triglyceride levels showed the strongest correlation at week 5 (Spearman correlation coefficient=0.36, p=0.005). Children >10 years had higher triglyceride levels as compared to younger patients(<10 years) adjusted for asparaginase preparations: median 4.9 mmol/L versus 1.6 mmol/L(p<0.001). In patients receiving Erwinia-asparaginase, triglyceride levels increased in the first weeks as well, but no grade 3/4 dyslipidemia was found. Hyperammonemia(grade 3/4) was only found in Erwinia-asparaginase treated patients(9%). Thrombosis occurred in 4.5%, pancreatitis in 7 %, and central neurotoxicity in 9 % of patients using each of both agents; these toxicities were not related to asparaginase activity levels nor to triglyceride levels. Severe dyslipidemia occurred frequently, but was temporary and was not associated with relevant clinical events and therefore should not be considered a reason for asparaginase treatment modifications. Only dyslipidemia was related to asparaginase activity levels.
    Haematologica 08/2014; DOI:10.3324/haematol.2014.109413 · 5.87 Impact Factor
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    ABSTRACT: The aim of this cross-sectional study was to analyze the incidence of incisional hernia after liver transplantation (LT), to determine potential risk factors for their development and to assess their impact of incisional hernia on health-related quality of life (HRQoL).Patients who underwent LT through a J-shaped incision with a minimum follow-up of 3 months were included. Follow-up was conducted at the outpatient clinic. Short form 36 (SF-36) and body image questionnaire (BIQ) were used for the assessment of HRQoL.A total of 140 patients was evaluated. The mean follow-up period was 33 (SD 20) months. Sixty patients (43%) were diagnosed with an incisional hernia. Multivariate analysis revealed surgical site infection (OR 5.27, p = 0.001), advanced age (OR 1.05, p = 0.003), and prolonged ICU stay (OR 1.54, p = 0.022) to be independent risk factors for development of incisional hernia after LT. Patients with an incisional hernia experienced significantly diminished HRQoL with respect to physical, social, and mental aspects.In conclusion, patients who undergo LT exhibit a high incidence of incisional hernia, which has a considerable impact on HRQoL. Development of incisional hernia was shown to be related to surgical site infection, advanced age and prolonged ICU stay.This article is protected by copyright. All rights reserved.
    Clinical Transplantation 05/2014; 28(7). DOI:10.1111/ctr.12386 · 1.49 Impact Factor
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    ABSTRACT: Background: To validate commonly used bedside right ventricular impedance parameters, which are used in determining heart-lung interactions during mechanical ventilation. Methods: Fifteen pigs were equally assigned to either an open or a closed pericardium group. In all animals, an inflatable vascular occluder and a flow probe were placed around the main pulmonary artery, which allowed for a gradual increase in pulmonary vascular impedance with banding of the pulmonary artery. A median sternotomy was performed for the open pericardium group, and a lateral thoracotomy was performed for the closed pericardium group. Results: In the open pericardium group, mean acceleration time (ACmean) and the slope of the pulmonary artery flow correlated significantly with Poiseuille resistance over the banding (r =0.67 and r = 0.65, respectively). In the closed pericardium group, the ratio of the right to left ventricular area, eccentricity index, and tricuspid annular plane systolic excursion did not correlate with resistance over the banding, only the ACmean showed a significant correlation with resistance over the banding (r = 0.88). Conclusions: ACmean is a reliable parameter of right ventricular impedance that can be used to study the heartlung interactions during mechanical ventilation.
    Minerva anestesiologica 03/2014; · 2.27 Impact Factor
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    ABSTRACT: Small airway obstruction is important in the pathophysiology of cystic fibrosis (CF) lung disease. Additionally, many CF patients lose lung function in the long term as a result of respiratory tract exacerbations (RTEs). No trials have been performed to optimize mucolytic therapy during a RTE. We investigated whether specifically targeting dornase alfa to the small airways improves small airway obstruction during RTEs. In a multi-center, double-blind, randomized controlled trial CF patients hospitalized for a RTE and on maintenance treatment with dornase alfa were switched to a smart nebulizer. Patients were randomized to small airway deposition (n = 19) or large airway deposition (n = 19) of dornase alfa for at least 7 days. Primary endpoint was forced expiratory flow at 75% of forced vital capacity (FEF75 ). Spirometry parameters improved significantly during admission, but the difference in mean change in FEF75 between treatment groups was not significant: 0.7 SD, P = 0.30. FEF25-75 , FEV1 , nocturnal oxygen saturation and diary symptom scores also did not differ between groups. This study did not detect a difference if inhaled dornase alfa was targeted to small versus large airways during a RTE. However, the 95% confidence interval for the change in FEF75 was wide. Further studies are needed to improve the effectiveness of RTE treatment in CF. Pediatr Pulmonol. © 2013 Wiley Periodicals, Inc.
    Pediatric Pulmonology 02/2014; 49(2). DOI:10.1002/ppul.22800 · 2.30 Impact Factor
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    ABSTRACT: This study prospectively analyzed the efficacy of very prolonged PEGasparaginase and Erwinia asparaginase (Erwinia-asp) courses in pediatric acute lymphoblastic leukemia (ALL) patients. Patients received 15 PEGasparaginase infusions (2,500 IU/m2 q2 weeks) in intensification after receiving native E.coli asparaginase in induction. In case of allergy to or silent inactivation of PEGasparaginase, Erwinia-asp (20,000 IU/m2 2-3 times weekly) was given. Eighty-nine patients were enrolled in the "PEGasparaginase study". Twenty(22%) of the PEGasparaginase-treated patients developed an allergy; seven (8%) showed silent inactivation. PEGasparaginase level was zero in all allergic patients (grade 1-4). Patients without hypersensitivity to PEGasparaginase had serum mean trough levels of 899 U/L. Fifty-nine patients were included in the "Erwinia-asp study", two (3%) developed an allergy and none silent inactivation. Ninety-six percent had at least one trough level ≥100 U/L. Serum asparagine level was not always completely depleted with Erwinia-asp in contrast to PEGasparaginase. Presence of asparaginase-antibodies was related to allergies and silent inactivation, but with low specificity (64%). Use of native E.coli asparaginase in induction leads to high hypersensitivity rates to PEGasparaginase in intensification. Therefore, PEGasparaginase should be used already in induction and we suggest that the dose could be lowered. Switching to Erwinia-asp leads to effective asparaginase levels in most patients. Therapeutic drug monitoring has been added to our ALL-11-protocol to individualize asparaginase therapy.
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    ABSTRACT: This study prospectively analyzed the efficacy of very prolonged PEGasparaginase and Erwinia-asparaginase (Erwinia-asp) courses in pediatric acute lymphoblastic leukemia (ALL) patients. Patients received 15 PEGasparaginase infusions (2,500IU/m(2) q2 weeks) in intensification after receiving native E.coli-asparaginase in induction. In case of allergy to or silent-inactivation of PEGasparaginase, Erwinia-asp(20,000IU/m(2) 2-3 times weekly) was given. Eighty-nine patients were enrolled in the "PEGasparaginase study". Twenty(22%) of the PEGasparaginase-treated patients developed an allergy; seven(8%) showed silent inactivation. PEGasparaginase level was zero in all allergic patients(grade 1-4). Patients without hypersensitivity to PEGasparaginase had serum mean trough levels of 899 U/L. Fifty-nine patients were included in the "Erwinia-asp study", two(3%) developed an allergy and none silent-inactivation. Ninety-six percent had at least one trough level ≥100 U/L. Serum asparagine level was not always completely depleted with Erwinia-asp in contrast to PEGasparaginase. Presence of asparaginase-antibodies was related to allergies and silent-inactivation, but with low specificity(64%). Use of native E.coli-asparaginase in induction leads to high hypersensitivity rates to PEGasparaginase in intensification. Therefore, PEGasparaginase should be used already in induction and we suggest that the dose could be lowered. Switching to Erwinia-asp leads to effective asparaginase levels in most patients. Therapeutic-drug-monitoring has been added to our ALL-11-protocol to individualize asparaginase therapy.
    Blood 01/2014; DOI:10.1182/blood-2013-10-534347 · 10.43 Impact Factor
  • Annals of Surgery 01/2014; 259(1):e7. DOI:10.1097/SLA.0b013e31827b9d21 · 7.19 Impact Factor
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    ABSTRACT: AimTo non-invasively study if compensation and decompensation occurs in the urinary bladder of healthy male volunteers in response to benign prostatic enlargement (BPE) using the condom catheter method. Methods Between 2001 and 2010, 1,020 healthy male volunteers were included in a longitudinal study based on three non-invasive urodynamic examinations during a 5-year follow-up. Inclusion criteria were an informed consent, the ability to void in a normal standing position and a minimum free flow rate of 5.4ml/sec. Study parameters were prostate volume (PV), maximum free urinary flow rate (Q(max)) and bladder contractility, quantified by the maximum isovolumetric bladder pressure, measured in the condom (P-cond.max). Volunteers also completed the International Prostate Symptom Score Form (IPSS). ResultsWithin limitations, the included volunteers had a flat age distribution between 38 and 72 years. This made it possible to combine longitudinal analysis in a 5-year observation interval, with cross sectional analysis in a 35-year age range. Longitudinal analysis showed that with increasing age, PV increased with 1.9% per year, whereas Q(max) decreased with 1.1% per year. IPSS increased with 1.1% per year when volunteers were older than 55 years. P-cond.max increased during the 5-year longitudinal follow-up, but not in the cross sectional analysis. Conclusions The difference between cross sectional and longitudinal results of the P-cond.max may have been caused by compensation of the urinary bladder resulting in a selection effect. This would imply that compensation is a relatively fast process, taking approximately 5 years. Neurourol. Urodynam. 33:78-84, 2014. (c) 2013 Wiley Periodicals, Inc.
    Neurourology and Urodynamics 01/2014; 33(1). DOI:10.1002/nau.22379 · 2.46 Impact Factor
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    ABSTRACT: Vitamin A is a multifunctional vitamin that can inhibit the formation of Th17 cells, which are probably involved in the development of relapses in MS. Furthermore, it promotes Treg formation. Therefore, vitamin A can be hypothesized to be lower in patients than in healthy controls, and to decrease relapse risk in relapsing-remitting MS (RRMS) patients. To compare vitamin A levels in MS patients and controls, and to investigate whether vitamin A levels are associated with relapse risk. In a case-control study all-trans-retinol levels were compared between 31 RRMS patients and 29 matched controls. In a prospective longitudinal study in 73 RRMS patients, serum samples for all-trans-retinol measurements were taken every eight weeks. Associations between all-trans-retinol concentrations and relapse rates were calculated using Poisson regression with the individual serum levels as time-dependent variable. Associations between vitamin A and vitamin D were calculated. Mean vitamin A levels were lower in patients (2.16μmol/l) than in controls (2.44μmol/l) but with borderline significance (p=0.05). In the longitudinal study, during follow-up (mean 1.7 years), 58 patients experienced a total of 139 relapses. Monthly moving averages of all-trans retinol levels were categorized into tertiles: a low (<2.9μmol/l), medium (2.9-3.7μmol/l) and high level (>3.7μmol/l). Relapse rates were not associated with serum all-trans retinol levels (p>0.2), in univariate nor in multivariate analysis. Serum concentrations of all-trans-retinol and 25-OH-vitamin D were positively correlated, although this correlation was weak (r=0.15). We did not find evidence for a role for vitamin A in the disease course of RRMS. We did find an association between vitamin A and D levels in the RRMS patients, possibly explained by dietary products that contain both fat-soluble vitamins. Copyright © 2013 The Authors. Published by Elsevier B.V. All rights reserved.
    01/2014; 3(1):34–39. DOI:10.1016/j.msard.2013.06.011
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    ABSTRACT: To elucidate incidence and risk factors of bone mineral density and fracture risk in children with Acute Lymphoblastic Leukemia (ALL). Prospectively, cumulative fracture incidence, calculated from diagnosis until one year after cessation of treatment, was assessed in 672 patients. This fracture incidence was compared between subgroups of treatment stratification and age subgroups (Log-Rank test). Serial measurements of bone mineral density of the lumbar spine (BMDLS) were performed in 399 ALL patients using dual energy X-ray absorptiometry. We evaluated risk factors for a low BMD (multivariate regression analysis). Osteoporosis was defined as a BMDLS≤-2 SDS combined with clinical significant fractures. The 3-years cumulative fracture incidence was 17.8%. At diagnosis, mean BMDLS of ALL patients was lower than of healthy peers (mean BMDLS=-1.10 SDS, P<0.001), and remained lower during/after treatment (8months: BMDLS=-1.10 SDS, P<0.001; 24months: BMDLS=-1.27 SDS, P<0.001; 36months: BMDLS=-0.95 SDS, P<0.001). Younger age, lower weight and B-cell-immunophenotype were associated with a lower BMDLS at diagnosis. After correction for weight, height, gender and immunophenotype, stratification to the high risk (HR)-protocol arm and older age lead to a larger decline of BMDLS (HR group: β=-0.52, P<0.01; age: β=-0.16, P<0.001). Cumulative fracture incidences were not different between ALL risk groups and age groups. Patients with fractures had a lower BMDLS during treatment than those without fractures. Treatment-related bone loss was similar in patients with and without fractures (respectively: ΔBMDLS=-0.36 SDS and ΔBMDLS=-0.12 SDS; interaction group time, P=0.30). Twenty of the 399 patients (5%) met the criteria of osteoporosis. Low values of BMDLS at diagnosis and during treatment, rather than the treatment-related decline of BMDLS, determines the increased fracture risk of 17.8% in children with ALL.
    Bone 11/2013; 59. DOI:10.1016/j.bone.2013.11.017 · 4.46 Impact Factor
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    ABSTRACT: No abstract available.
    Pediatric Blood & Cancer 11/2013; DOI:10.1002/pbc.24661 · 2.56 Impact Factor
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    Dataset: JPO HADS
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    ABSTRACT: After a more successful treatment of pediatric cancer, the number of childhood cancer survivors is progressively increasing. Consequently, awareness of psychological late sequelae is important. The Hospital Anxiety and Depression Scale (HADS) was used as a screening tool for emotional distress in a single center cohort of 652 childhood cancer survivors (median age 23 y [range, 15 to 46 y], median follow-up time 15 y [range, 5 to 42 y]). Results were compared with a control group of 440 Dutch subjects. A higher HADS score linearly reflect a higher level of emotional distress, and a score ≥15 is indicative of clinically significant emotional distress. Mean HADS score of the childhood cancer survivors was not different from the control group (P=0.38). Survivors exposed to global central nervous system (CNS) irradiation had a significantly higher HADS score than the control group (8.3±6.6; P=0.05) as well as other survivors (P=0.01). Forty-three survivors (7%) had a HADS score ≥15. Survivors with a HADS score ≥15 were variously spread over the diagnostic-related and treatment-related subgroups. Linear regression analysis showed that high educational achievement (β=-1.28; P<0.01) and age at the time of the study (β=0.08; P=0.03) were both significantly associated with the HADS score. Emotional distress does not occur more often in childhood cancer survivors than in the normal population. No disease-related or treatment-related variable was independently associated with emotional distress.
    Journal of Pediatric Hematology/Oncology 10/2013; 35(7):525-9. DOI:10.1097/MPH.0b013e31829f2799 · 0.96 Impact Factor
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    ABSTRACT: Randomized studies support the closure of midline incisions with a suture length to wound length ratio (SL:WL) of more than 4, accomplished with small tissue bites and short stitch intervals to decrease the risk of incisional hernia and wound infection. We investigated practical aspects of this technique possibly hampering the introduction of this technique. Patient data, operative variables and SL:WL ratio were collected at two hospitals: Sundsvall Hospital (SH) and Erasmus University Medical Center (EMC). A structured implementation of the technique had been performed at SH but not at EMC. Personnel were interviewed by questionnaire. At each hospital, 18 closures were analyzed. Closure time was significantly longer (p = 0.023) at SH (median 18 minutes, range: 9-59) than at EMC (median 13 minutes, range: 5-23). An SL:WL ratio of more than 4 was achieved in 8 of 18 cases at EMC and in all 18 cases at SH. We conclude that calculation of an SL:WL ratio is easily performed. Suturing with the small bite-short stitch interval technique of SH required 5 minutes extra, outweighing the morbidity of incisional hernia. Without a structured implementation to suture with an SL:WL ratio of more than 4, a lower ratio is often achieved.
    Surgical technology international 09/2013; XXIII.
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    ABSTRACT: In chronic obstructive pulmonary disease (COPD), there is a poor correlation between forced expiratory volume in 1 s (FEV1) and dyspnea following bronchodilator use. Better correlations have been observed between inspiratory lung function parameters (ILPs) and dyspnea, which drives our interest in ILPs. However, the acute and prolonged effects of long-acting bronchodilators and oral corticosteroids on ILPs have not been well investigated. Therefore, the aim of this study was to investigate the effects of these treatments on the ILPs, FEV1, dyspnea (visual analog scale (VAS)) and clinical COPD questionnaire (CCQ).
    Pulmonary Pharmacology &amp Therapeutics 09/2013; 28(2). DOI:10.1016/j.pupt.2013.09.002 · 2.57 Impact Factor
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    ABSTRACT: To investigate the implementation of the International Confederation of Midwives/ International Federation of Gynecology and Obstetrics (ICM/ FIGO) guideline on active third stage management in vaginal deliveries in daily clinical practice. Observational, cross-sectional study. One tertiary and one teaching hospital in the Netherlands. Population Women undergoing vaginal deliveries. A case record form was completed after every vaginal delivery. Primary outcome was adequate guideline adherence, defined as initial administration of 10 IU oxytocin, performance of controlled cord traction and uterine massage. Adequate guideline adherence was a priori estimated to be 10%. With a sample size of 600, i.e. 300 women per hospital, the standard error of the resulting percentage would be less than 2% for each hospital. Six-hundred-twenty-six women were included. Guideline adherence was adequately performed in 48% of vaginal deliveries. Oxytocin was administered after birth in 98% of deliveries and in 80% the correct dose was used. Controlled cord traction was performed in 63% and uterine massage in 93%; however, the latter was performed as advised (at least eight times) in only 8%. The amount of blood loss was not associated with the use of either 5 or 10 IU oxytocin (p = 0.818). Controlled cord traction and uterine massage were more frequently performed when blood loss exceeded 500 mL (p < 0.001). Active third stage management according to the ICM/FIGO guideline is adequately performed in only 48% of all vaginal deliveries. Results of this study call for training programs to enhance adherence to the ICM/ FIGO guideline. This article is protected by copyright. All rights reserved.
    Acta Obstetricia Et Gynecologica Scandinavica 08/2013; 92(11). DOI:10.1111/aogs.12238 · 1.99 Impact Factor

Publication Stats

27k Citations
3,864.92 Total Impact Points

Institutions

  • 1998–2015
    • Erasmus MC
      • • Department of Biostatistics
      • • Department of Surgery
      • • Department of Radiology
      • • Department of Pediatrics
      • • Department of Oncological Surgery
      Rotterdam, South Holland, Netherlands
  • 1980–2015
    • Erasmus Universiteit Rotterdam
      • • Department of Pediatrics/Respiratory Medicine
      • • Department of Obstetrics and Gynaecology
      • • Department of Epidemiology
      • • Department of Surgery
      • • Department of Immunology
      • • Department of Pathology
      • • Department of Anesthesiology
      • • Department of Internal Medicine
      • • Department of Urology
      Rotterdam, South Holland, Netherlands
  • 2011–2013
    • Leiden University Medical Centre
      Leyden, South Holland, Netherlands
  • 2009
    • IJsselland Ziekenhuis
      Kapelle, South Holland, Netherlands
    • HagaZiekenhuis van Den Haag
      's-Gravenhage, South Holland, Netherlands
  • 2008
    • Delft University Of Technology
      • Department of Industrial Design
      Delft, South Holland, Netherlands
  • 2005–2008
    • Canadian Society for Epidemiology and Biostatistics 
      Canada
  • 2007
    • Harvard Medical School
      • Department of Medicine
      Boston, Massachusetts, United States
    • Medisch Centrum Alkmaar
      Alkmaar, North Holland, Netherlands
    • University of Groningen
      Groningen, Groningen, Netherlands
    • University Medical Center Utrecht
      • Urology
      Utrecht, Utrecht, Netherlands
  • 2003–2005
    • Radboud University Nijmegen
      • Department of Pulmonary Diseases
      Nymegen, Gelderland, Netherlands
    • Karolinska Institutet
      • Department of Oncology-Pathology
      Solna, Stockholm, Sweden
    • George Washington University
      • Department of Pediatrics
      Washington, Washington, D.C., United States
  • 2001–2005
    • Maastricht Universitair Medisch Centrum
      Maestricht, Limburg, Netherlands
    • University of Iowa Children's Hospital
      Iowa City, Iowa, United States
  • 2004
    • St Anna's Kinderspital
      Wien, Vienna, Austria
  • 2003–2004
    • Groene Hart Ziekenhuis
      Guda, South Holland, Netherlands
  • 2002
    • University of Milan
      Milano, Lombardy, Italy
  • 1992–2002
    • Het Oogziekenhuis Rotterdam
      Rotterdam, South Holland, Netherlands
  • 2000
    • University of California, San Francisco
      San Francisco, California, United States
    • VU University Amsterdam
      Amsterdamo, North Holland, Netherlands
  • 1996–1998
    • Catharina Hospital
      Eindhoven, North Brabant, Netherlands
  • 1994
    • Diergaarde Blijdorp
      Rotterdam, South Holland, Netherlands
  • 1991
    • Eindhoven Cancer Registry
      Eindhoven, North Brabant, Netherlands
  • 1984
    • Zeeuws Radiotherapeutisch Instituut
      Flushing, Zeeland, Netherlands
  • 1982–1983
    • Arnhem Radiotherapy Institute
      Arnheim, Gelderland, Netherlands