Gerard H A Visser

Gerard H A Visser
University Medical Center Utrecht | UMC Utrecht · Department of Obstetrics

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828
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Publications

Publications (828)
Article
Full-text available
Introduction Following the detection of fetal growth restriction, there is no consensus about the criteria that should trigger delivery in the late preterm period. The consequences of inappropriate early or late delivery are potentially important yet practice varies widely around the world, with abnormal findings from fetal heart rate monitoring in...
Article
This article reviews the literature about the diagnosis, antepartum surveillance, and timing of delivery of fetuses suspected to be small for gestational age/growth restricted. Several guidelines have been issued by major professional organizations, including ISUOG and SMFM. The differences in recommendations, in particular about the use of Doppler...
Article
Purpose To assess the longitudinal variation of the ratio of umbilical and cerebral artery pulsatility index (UCR) in late preterm fetal growth restriction (FGR). Materials and Methods A prospective European multicenter observational study included women with a singleton pregnancy, 32+ 0–36+ 6, at risk of FGR (estimated fetal weight [EFW] or abdomi...
Article
Objective Postpartum haemorrhage (PPH) complicates approximately 5% of births worldwide and is a leading direct cause of maternal death. Rates of PPH are increasing in many developed countries, particularly PPH related to uterine atony. There is a lack of published up-to-date information about healthcare resource use associated with management of P...
Article
Full-text available
Background Indicators to evaluate progress towards timely access to safe surgical, anaesthesia, and obstetric (SAO) care were proposed in 2015 by the Lancet Commission on Global Surgery. These aimed to capture access to surgery, surgical workforce, surgical volume, perioperative mortality rate, and catastrophic and impoverishing financial consequen...
Preprint
Full-text available
Background Indicators to evaluate progress towards timely access to safe surgical, anaesthesia, and obstetric (SAO) care were proposed in 2015 by the Lancet Commission on Global Surgery. Despite being rapidly taken up by practitioners, datapoints from which to derive them were not defined, limiting comparability across time or settings. We convened...
Article
The COVID-19 pandemic exposed weaknesses in multiple domains and widened gender-based inequalities across the world. It also stimulated extraordinary scientific achievement, bringing vaccines to the public in under a year. In this article, we discuss the implications of current vaccination guidance for pregnant and lactating women, whether their ex...
Article
Hypertensive disorders are a leading cause of maternal morbidity and mortality worldwide. Despite advances in prevention and clinical management, women in low‐resource countries continue to bear the burden of the sequelae of severe pre‐eclampsia–eclampsia. Sustainable strategies to improve the care of women with hypertensive disease, to identify th...
Article
Publication of the Intergrowth‐21st and WHO growth charts raises the question of which growth data prenatal providers should use in clinical practice. Is it better to use a universal chart applied globally, or metrics based on local or regional growth patterns? And what about customized charts versus local charts? FIGO has reviewed the different gr...
Article
Pregnant women and their fetuses are among the vulnerable populations that can be severely affected by communicable diseases. As such, some vaccines such as the influenza and the Tdap (tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis) vaccines are strongly recommended in each pregnancy, with generally safe profiles. Other vaccines...
Article
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The introduction of anti‐Rh(D) immunoglobulin more than 50 years ago has resulted in only a 50% decrease in Rhesus disease globally owing to a low uptake of this prophylactic approach. The International Federation of Gynecology and Obstetrics, International Confederation of Midwives, and Worldwide Initiative for Rhesus Disease Eradication have revi...
Article
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In the mid-20th century, Hemolytic Disease of the Fetus and Newborn, caused by maternal alloimmunization to the Rh(D) blood group antigen expressed by fetal red blood cells (i.e., “Rh disease”), was a major cause of fetal and neonatal morbidity and mortality. However, with the regulatory approval, in 1968, of IgG anti-Rh(D) immunoprophylaxis to pre...
Article
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Objectives: To explore the association between fetal umbilical and middle cerebral artery (MCA) Doppler abnormalities and outcome in late preterm pregnancies at risk of fetal growth restriction. Methods: This was a prospective cohort study of singleton pregnancies at risk of fetal growth restriction at 32 + 0 to 36 + 6 weeks of gestation, enroll...
Article
The diagnostic criteria for GDM continue to be debated. The arguments presented here may help to dissipate confusion and help build global consensus. Hyperglycemia is one of the most common medical complications of pregnancy. The International Diabetes Federation (IDF) estimates that, globally, one in six of the 20 million annual live births (16.8...
Article
There remains uncertainty about the optimal route of delivering carefully selected breech babies at term. This review argues strongly that vaginal mode of delivery should be considered in selected cases rather than offering an elective caesarean section for every patient.
Article
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Objectives: To identify antenatal ultrasound markers and their predictive value in differentiating between simple and complex gastroschisis. Methods: Prospective nationwide study in which serial longitudinal ultrasound examinations were performed at regular specified intervals between 20 and 37 weeks in isolated fetal gastroschisis cases. The pr...
Article
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Objective: To determine whether complex gastroschisis (i.e. intestinal atresia, perforation, necrosis or volvulus) can prenatally be distinguished from simple gastroschisis by fetal stomach volume and stomach-bladder distance, using three-dimensional (3D) ultrasound. Methods: This multicenter prospective cohort study was conducted in the Netherl...
Article
Purpose To investigate the effects of the antenatal administration of betamethasone on fetal Doppler and short term fetal heart rate variation (CTG-STV) in early growth restricted (FGR) fetuses. Materials and Methods Post hoc analysis of data derived from the TRUFFLE study, a prospective, multicenter, randomized management trial of severe early ons...
Article
To facilitate delivery and avoid perineal lacerations, episiotomy has been widely used to enlarge the birth canal. Although there is a global trend for reduced episiotomy rates [1], these continue to be very high in some centers and areas of the world, with rates up to 60 and 80% in India and China, respectively [2,3]. There is no universally accep...
Article
Severe morbidity and death because of Rh disease have only been reduced by approximately 50% globally during the last 50 years, despite the advent of anti-Rh(D) immunoglobin prophylaxis, which has resulted in >160,000 perinatal deaths and 100,000 disabilities annually. This apparent failure to take appropriate preventive measures is of great concer...
Article
Purpose: Third trimester maternal perception of fetal movements is often used to assess fetal well-being. However, its true clinical value is unknown, primarily because of the variability in subjective quantification. The actograph, a technology available on most cardiotocograph machines, quantifies movements, but has never previously been investig...
Article
International standards for clinical staffing of delivery care in maternity units are currently lacking, with resulting gaps in provision leading to adverse outcomes and very poor experiences of care for women and families. While evidence‐informed modelling approaches have been proposed based on population characteristics and estimated rates of com...
Article
Many studies have reported on the association of reduced fetal movements and stillbirth, but little is known about excessive fetal movements and adverse pregnancy outcome. First described in 1977, sudden excessive fetal movement was noted to reflect acute fetal distress and subsequent fetal demise. Subsequently, little was reported regarding this p...
Article
Background: Although the evidence regarding the benefit of using ST waveform analysis of the fetal electrocardiogram is conflicting, ST waveform analysis is considered as adjunct to identify fetuses at risk for asphyxia in our center. Most randomized controlled trials and meta-analyses have not shown a significant decrease in umbilical metabolic a...
Article
Full-text available
Objective: To determine acceptable and achievable strategies of intrapartum fetal monitoring in busy low-resource settings. Methods: Three rounds of online Delphi surveys were conducted between January 1 and October 31, 2017. International experts with experience in low-resource settings scored the importance of intrapartum fetal monitoring meth...
Article
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A caesarean section (CS) can be a life-saving intervention when medically indicated, but this procedure can also lead to short-term and long-term health effects for women and children. Given the increasing use of CS, particularly without medical indication, an increased understanding of its health effects on women and children has become crucial, w...
Book
Cambridge Core - Obstetrics and Gynecology, Reproductive Medicine - Placental-Fetal Growth Restriction - by Christoph Lees
Article
The continuing rise in the global prevalence of diabetes and overweight or obesity has become a major burden for global health, as the pandemic is affecting both high and low-middle income countries (LMIC). At the same time, a similar pattern has been observed for all forms of hyperglycemia in pregnancy (HIP), diabetes during pregnancy and gestatio...
Article
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Objectives: To establish reference curves of normal fetal small bowel and colon diameters and to assess the clinical applicability. Method: Serial longitudinal ultrasound examinations at four-weekly intervals between 20 to 41 weeks of gestation in 39 low-risk fetuses. The largest loop of the small bowel and colon was identified. The bowel lumen sho...
Article
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Aims/hypothesis: Gestational diabetes mellitus (GDM) is reported to be associated with childhood obesity, however the magnitude of this association and relation to intrauterine growth is uncertain. We, therefore, aimed to assess whether the growth trajectories of large for gestational age (LGA) and non-LGA offspring of mothers with GDM (OGDM) are...
Article
Hyperglycemia in pregnancy (HIP) is recognized as a major underlying cause of pregnancy complications and a contributing cause to health risks throughout the subsequent life of both mothers and babies, with amplification of the global epidemic of non-communicable diseases. Although some aspects of these associations are well described, detailed und...
Article
Background: Early-onset fetal growth restriction represents a particular dilemma in clinical management balancing the risk of iatrogenic prematurity with waiting for the fetus to gain more maturity, while being exposed to the risk of intrauterine death or the sequelae of acidosis. Objective: The Trial of Umbilical and Fetal Flow in Europe was a...
Article
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Background Intrapartum antibiotic chemoprophylaxis (IAP) prevents most early-onset group B streptococcal (GBS) disease. However, there is no description of how IAP is used around the world. This article is the sixth in a series estimating the burden of GBS disease. Here we aimed to review GBS screening policies and IAP implementation worldwide. Me...
Article
Objective: To investigate possible associations between remifentanil and the appearance of sinusoidal heart rate patterns in fetuses, and neonatal outcomes. Methods: The present retrospective cohort study included data from patients at over 37 weeks of singleton or multiple pregnancies attending Zuyderland Medical Center, Sittard, the Netherland...
Article
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OBJECTIVE: In the TRUFFLE study on outcome of early fetal growth restriction women were allocated to three timing of delivery plans according to antenatal monitoring strategies based on reduced computerized cardiotocographic heart rate short term variation (c-CTG STV) , early Ductus Venosus (DV p95) or late DV (DV noA) changes. However, many infant...
Article
Full-text available
https://deepblue.lib.umich.edu/bitstream/2027.42/138200/2/ijgo12181_am.pdf
Chapter
Electronic fetal heart rate monitoring or cardiotocography (CTG) has been introduced in the 1970s. It has resulted in a 1.6-fold increase in cesarean deliveries (CD; [1]) for fetal distress but has hardly resulted in improvements in neonatal outcome. As stated in an editorial in the American Journal of Obstetrics and Gynecology, “ The hope that thi...
Article
Introduction: Worldwide induction and cesarean delivery rates have increased rapidly, with consequences for subsequent pregnancies. The majority of intra-partum cesarean deliveries are performed for failure to progress, typically in nulliparous women at term. Current uterine registration techniques fail to identify inefficient contractions leading...
Article
Purpose. Donor milk (DM) represents an important nutrition source for high-risk newborns. Holder pasteurization (HoP) is the most recommended procedure for DM treatment, providing a good compromise between microbiological safety and biological quality. HoP was previously shown to affect DM cytokines, growth factors and hormones levels, whilst no da...
Article
Full-text available
Background Reduced fetal middle cerebral artery Doppler impedance is associated with hypoxemia in fetal growth restriction. It remains unclear as to whether this finding could be useful in timing delivery, especially in the third trimester. In this regard there is a paucity of evidence from prospective studies. Objectives The aim of this study was...
Article
Full-text available
Background To improve early risk-identification in pregnancy, research on prediction models for common pregnancy complications is ongoing. Therefore, it was the aim of this study to explore pregnant women’s perceptions, preferences and needs regarding prediction models for first trimester screening for common pregnancy complications, such as preecl...
Article
Full-text available
Advances in the management of respiratory distress syndrome (RDS) ensure that clinicians must continue to revise current practice. We report the third update of the European Guidelines for the Management of RDS by a European panel of expert neonatologists including input from an expert perinatal obstetrician based on available literature up to the...
Article
BACKGROUND Infants of women with pregestational diabetes are at risk for developing obesity in later life. This study aimed to identify subgroups at highest risk, by studying growth profiles of offspring from women with type 1 or 2 diabetes mellitus (ODM1, ODM2) until the age of 14 years.METHODS Information from infant welfare centers was received...
Article
Full-text available
Objective: In the TRUFFLE study on outcome of early fetal growth restriction women were allocated to three timing of delivery plans according to antenatal monitoring strategies based on reduced computerized cardiotocographic heart rate short term variation (c-CTG STV) , early Ductus Venosus (DV p95) or late DV (DV noA) changes. However, many infan...
Article
Background: Phase-rectified signal averaging, an innovative signal processing technique, can be used to investigate quasi-periodic oscillations in noisy, nonstationary signals that are obtained from fetal heart rate. Phase-rectified signal averaging is currently the best method to predict survival after myocardial infarction in adult cardiology. A...
Article
The aim of this Editorial is to review Level I evidence regarding the effectiveness of interventions in women identified as having short cervix on mid-trimester ultrasound, discuss some of the remaining challenges and outline areas for future research.
Article
Background: Pregnancies complicated by maternal diabetes are associated with disproportionate intrauterine growth that subsequently may lead to pediatric adiposity. Objectives: We investigated whether disproportionate intrauterine growth leads to differences in BMI in 4- to 5-year-old offspring from pregnancies complicated by type 1 (ODM1), type...
Article
Objective The objective of this study was to assess possible day–night differences in perinatal and maternal labor outcomes in a hospital setting with no day–night differences in the presence of experienced medical staff. Design This was a retrospective study conducted over 5 years between 2008 and 2012. Setting This study was set at the obstetric...
Article
Background: Twin pregnancies are at increased risk for perinatal morbidity and mortality, due to many factors including a high incidence of preterm delivery. Compared to singleton pregnancies overall perinatal mortality risk is higher in twin pregnancies, however for the preterm period perinatal mortality has been reported to be lower in twins. O...
Article
Full-text available
Introduction: There is evidence that mother's own milk is the best nutrient in terms of multiorgan protection and infection prevention. However, when maternal milk is scarce, the solution can be represented by donor milk (DM), which requires specific storage procedures such as Holder Pasteurization (HoP). HoP is not free from side effects since it...
Article
Objectives: To explore if in early fetal growth restriction (FGR) the longitudinal pattern of short-term fetal heart rate (FHR) variation (STV) can be used for identifying imminent fetal distress and if abnormalities of FHR registration associate with two-year infant outcome. Methods: The original TRUFFLE study assessed if in early FGR the use o...
Article
Full-text available
Objectives: In the recent TRUFFLE study it appeared that, in pregnancies complicated by fetal growth restriction (FGR) between 26 and 32 weeks, monitoring of the ductus venosus (DV) combined with computerised cardiotocography (cCTG) as a trigger for delivery, increased the chance of infant survival without neurological impairment. However, concern...
Article
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Background Uptake rates for Down syndrome screening in the Netherlands are low compared to other European countries. To investigate the low uptake, we explored women’s reasons for participation and possible influences of national healthcare system characteristics. Dutch prenatal care is characterised by an approach aimed at a low degree of medicali...