A J van Loon

Publications (8)3.41 Total impact

• Article: Gestational Hypertension or Preeclampsia at Term (HYPITAT Trial)

  S.M.C. Vijgen, C.M. Koopmans, B.C. Opmeer, H. Groen, D. Bijlenga, J.G. Aarnoudse, D.J. Bekedam, P.P. van den Berg, K. de Boer, J.M. Burggraaff, [......], A. Lub, D.N.M. Papatsonis, J.A.M. van der Post, F.J.M.E. Roumen, H.C.J. Scheepers, R.H. Stigter, C. Willekes, B.W.J. Mol, M.G. Van Pampus, HYPITAT study group
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  ABSTRACT: (BJOG. 2010;117(13):1577–85)
  Obstetric Anesthesia Digest 11/2011; 31(4):237–238.
• Source

  Available from: Henk Groen

  Article: An economic analysis of induction of labour and expectant monitoring in women with gestational hypertension or pre-eclampsia at term (HYPITAT trial).

  S M C Vijgen, C M Koopmans, B C Opmeer, H Groen, D Bijlenga, J G Aarnoudse, D J Bekedam, P P van den Berg, K de Boer, J M Burggraaff, [......], A J van Loon, A Lub, D N M Papatsonis, J A M van der Post, F J M E Roumen, H C J Scheepers, R H Stigter, C Willekes, B W J Mol, M G Van Pampus
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  ABSTRACT: To assess the economic consequences of labour induction compared with expectant monitoring in women with gestational hypertension or pre-eclampsia at term. An economic analysis alongside the Hypertension and Pre-eclampsia Intervention Trial At Term (HYPITAT). Obstetric departments of six university and 32 teaching and district hospitals in the Netherlands. Women diagnosed with gestational hypertension or pre-eclampsia between 36(+0) and 41(+0) weeks of gestation, randomly allocated to either induction of labour or expectant monitoring. A trial-based cost-effectiveness analysis was performed from a societal perspective during a 1-year time horizon. One-year costs were estimated and health outcomes were expressed as the prevalence of poor maternal outcome defined as either maternal complications or progression to severe disease. The average costs of induction of labour (n = 377) were €7077 versus €7908 for expectant monitoring (n = 379), with an average difference of -€831 (95% CI -€1561 to -€144). This 11% difference predominantly originated from the antepartum period: per woman costs were €1259 for induction versus €2700 for expectant monitoring. During delivery, more costs were generated following induction (€2190) compared with expectant monitoring (€1210). No substantial differences were found in the postpartum, follow-up and for non-medical costs. In women with gestational hypertension or mild pre-eclampsia at term, induction of labour is less costly than expectant monitoring because of differences in resource use in the antepartum period. As the trial already demonstrated that induction of labour results in less progression to severe disease without resulting in a higher caesarean section rate, both clinical and economic consequences are in favour of induction of labour in these women. The trial has been registered in the clinical trial register as ISRCTN08132825.
  BJOG An International Journal of Obstetrics & Gynaecology 12/2010; 117(13):1577-85. · 3.41 Impact Factor
• Article: [Induction of labour versus expectant monitoring for gestational hypertension and mild pre-eclampsia after 36 weeks' gestation: the HYPITAT trial.]

  C.M. Koopmans, D. Bijlenga, H Groen, S.M.C. Vijgen, J G Aarnoudse, D.J. Bekedam, P.P. van den Berg, K. de Boer, J.M. Burggraaff, K.W.M. Bloemenkamp, [......], A. Kwee, A J van Loon, A. Lub, D.N.M. Papatsonis, J.A.M. van der Post, F.J.M.E. Roumen, H.C.J. Scheepers, C. Willekes, B.W.J. Mol, M.G. van Pampus
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  ABSTRACT: OBJECTIVE: To investigate what would benefit women with mild full-term pregnancy-related hypertension most: induction of labour or expectant monitoring, from the perspective of clinical effectiveness, maternal quality of life, and costs. DESIGN: Randomised clinical trial. Trial registration number ISRCTN08132825. METHODS: We undertook a multicentre randomised controlled trial in 38 hospitals in the Netherlands between October 2005 and March 2008. We enrolled patients with a singleton pregnancy in cephalic presentation at 36-41 weeks' gestation, who had gestational hypertension or mild preeclampsia. Participants were randomly allocated to receive either induction of labour or expectant monitoring. The primary outcome was a composite measure of poor maternal outcome, defined as maternal mortality, maternal morbidity (eclampsia, 'haemolysis, elevated liver enzymes, low platelets' (HELLP) syndrome, pulmonary oedema, thrombo-embolic disease and abruptio placentae), progression to severe hypertension or proteinuria, and major postpartum haemorrhage. Secondary outcomes were mode of delivery, neonatal outcome, maternal quality of life and costs. Analysis was by intention to treat. RESULTS: A total of 756 patients were allocated to receive induction of labour (n = 377 patients) or expectant monitoring (n = 379). No cases of maternal or neonatal death or eclampsia were recorded. Development of poor maternal outcome was significantly lower in the induction of labour group (117 women) than the expectant monitoring group (166 women) (31% versus 44%; relative risk 0.71 (95% CI: 0.59-0.86); p < 0.001). The caesarean section rate was lower among women in the induction of labour group (n = 54) compared to women in the expectant monitoring group (n = 72) (14% versus 19%; relative risk 0.75 (95% CI: 0.55-1.04)< p = 0.085). Neonatal outcomes and quality of life were comparable between both groups. Induction of labour is a cost saving strategy (difference euro 831). CONCLUSION: For women with full-term gestational hypertension and pre-eclampsia, induction of labour is associated with improved maternal outcome and lower costs, without the additional risk of a caserian section being necessary.
  Nederlands tijdschrift voor geneeskunde 01/2010; 154(22):A1660.
• Article: [Liver rupture in pregnancy: a life-threatening complication of the HELLP syndrome].

  R A Weemhoff, A J van Loon, J G Aarnoudse
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  ABSTRACT: A 31-year-old primigravida with pre-existent hypertension was admitted at 28.5 weeks gestation with foetal growth retardation. On the third day after admission she developed a 'haemolysis, elevated liver enzymes and low platelets' (HELLP) syndrome with severe pain in the epigastrium. Intrauterine death had occurred and abruptio placentae was suspected. Induction of labour was started with intravenous prostaglandins. The next day the haemoglobin concentration had decreased despite transfusions of red blood cell concentrates. At ultrasound examination, free fluid was detected in the abdomen and at explorative laparotomy a subcapsular liver haematoma appeared to have ruptured. An intrahepatic haematoma does not require operative treatment, unless it has ruptured. Packing of the ruptured liver with gauze and later removal of the gauze is preferable to lobectomy.
  Nederlands tijdschrift voor geneeskunde 11/1996; 140(43):2140-2.
• Article: Induction of labor versus expectant monitoring for gestational hypertension or mild preeclampsia after 36 weeks' gestation (HYPITAT): a multicentre, open-label randomized controlled trial (editorial comment)

  C.M. Koopmans, D. Bijlenga, H Groen, S.M.C. Vijgen, J G Aarnoudse, D.J. Bekedam, P.P. van den Berg, K. de Boer, J.M. Burggraaff, K.W.M. Bloemenkamp, [......], A. Kwee, A J van Loon, A. Lub, D.N.M. Papatsonis, J.A.M. van der Post, F.J.M.E. Roumen, H.C.J. Scheepers, C. Willekes, B.W.J. Mol, M.G. van Pampus
• Article: Induction of labour versus expectant monitoring for gestational hypertension or mild pre-eclampsia after 36 weeks' gestation (HYPITAT): a multicentre, open-label randomised controlled trial.

  C.M. Koopmans, D. Bijlenga, H Groen, S.M. Vijgen, J G Aarnoudse, D.J. Bekedam, P.P. van den Berg, K. de Boer, J.M. Burggraaf, K.W.M. Bloemenkamp, [......], A. Kwee, A J van Loon, A. Lub, D N Papatsonis, J A van der Post, F J Roumen, H.C. Scheepers, C. Willekes, B.W.J. Mol, M.G. van Pampus
• Article: Liever inleiden dan afwachten bij aterme zwangerschapshypertensie en milde preeclampsie: HYPITAT-studie

  C.M. Koopmans, D. Bijlenga, H Groen, S.M. Vijgen, J G Aarnoudse, D.J. Bekedam, P.P. van den Berg, Boer K. de, J.M. Burggraaff, K W Bloemenkamp, [......], A. Kwee, A J van Loon, A. Lub, D N Papatsonis, J A van der Post, F J Roumen, H.C. Scheepers, C. Willekes, B W Mol, M.G. van Pampus
  [show abstract] [hide abstract]
  ABSTRACT: OBJECTIVE: To investigate what would benefit women with mild full-term pregnancy-related hypertension most: induction of labour or expectant monitoring, from the perspective of clinical effectiveness, maternal quality of life, and costs. DESIGN: Randomised clinical trial. Trial registration number ISRCTN08132825. METHODS: We undertook a multicentre randomised controlled trial in 38 hospitals in the Netherlands between October 2005 and March 2008. We enrolled patients with a singleton pregnancy in cephalic presentation at 36-41 weeks' gestation, who had gestational hypertension or mild preeclampsia. Participants were randomly allocated to receive either induction of labour or expectant monitoring. The primary outcome was a composite measure of poor maternal outcome, defined as maternal mortality, maternal morbidity (eclampsia, 'haemolysis, elevated liver enzymes, low platelets' (HELLP) syndrome, pulmonary oedema, thrombo-embolic disease and abruptio placentae), progression to severe hypertension or proteinuria, and major postpartum haemorrhage. Secondary outcomes were mode of delivery, neonatal outcome, maternal quality of life and costs. Analysis was by intention to treat. RESULTS: A total of 756 patients were allocated to receive induction of labour (n = 377 patients) or expectant monitoring (n = 379). No cases of maternal or neonatal death or eclampsia were recorded. Development of poor maternal outcome was significantly lower in the induction of labour group (117 women) than the expectant monitoring group (166 women) (31% versus 44%; relative risk 0.71 (95% CI: 0.59-0.86); p < 0.001). The caesarean section rate was lower among women in the induction of labour group (n = 54) compared to women in the expectant monitoring group (n = 72) (14% versus 19%; relative risk 0.75 (95% CI: 0.55-1.04)< p = 0.085). Neonatal outcomes and quality of life were comparable between both groups. Induction of labour is a cost saving strategy (difference euro 831). CONCLUSION: For women with full-term gestational hypertension and pre-eclampsia, induction of labour is associated with improved maternal outcome and lower costs, without the additional risk of a caesarean section being necessary
• Article: An economic analysis of induction of labour and expectant monitoring in women with gestational hypertension or pre-eclampsia at term (HYPITAT trial)

  S.M.C. Vijgen, C.M. Koopmans, B C Opmeer, H Groen, D. Bijlenga, J G Aarnoudse, D.J. Bekedam, P.P. van den Berg, K. de Boer, J.M. Burggraaff, [......], A J van Loon, A. Lub, D.N.M. Papatsonis, J.A.M. van der Post, F.J.M.E. Roumen, H.C.J. Scheepers, R.H. Stigter, C. Willekes, B.W.J. Mol, M.G. van Pampus
  [show abstract] [hide abstract]
  ABSTRACT: Objective To assess the economic consequences of labour induction compared with expectant monitoring in women with gestational hypertension or pre-eclampsia at term. Design An economic analysis alongside the Hypertension and Preeclampsia Intervention Trial At Term (HYPITAT). Setting Obstetric departments of six university and 32 teaching and district hospitals in the Netherlands. Population Women diagnosed with gestational hypertension or pre-eclampsia between 36(+0) and 41(+0) weeks of gestation, randomly allocated to either induction of labour or expectant monitoring. Methods A trial-based cost-effectiveness analysis was performed from a societal perspective during a 1-year time horizon. Main outcome measures One-year costs were estimated and health outcomes were expressed as the prevalence of poor maternal outcome defined as either maternal complications or progression to severe disease. Results The average costs of induction of labour (n = 377) were (sic)7077 versus (sic)7908 for expectant monitoring (n = 379), with an average difference of -(sic)831 (95% CI -(sic)1561 to -(sic)144). This 11% difference predominantly originated from the antepartum period: per woman costs were (sic)1259 for induction versus (sic)2700 for expectant monitoring. During delivery, more costs were generated following induction ((sic)2190) compared with expectant monitoring ((sic)1210). No substantial differences were found in the postpartum, follow-up and for non-medical costs. Conclusion In women with gestational hypertension or mild pre-eclampsia at term, induction of labour is less costly than expectant monitoring because of differences in resource use in the antepartum period. As the trial already demonstrated that induction of labour results in less progression to severe disease without resulting in a higher caesarean section rate, both clinical and economic consequences are in favour of induction of labour in these women