Tom H M Hasaart

Tom H M Hasaart
Catharina Ziekenhuis · Department of Gynecology

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122
Publications
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Publications

Publications (122)
Article
Full-text available
Background Fetal heart rate abnormalities (FHR) during and after external cephalic version (ECV) are relatively frequent. They may raise concern about fetal wellbeing. Only occasionally they may lead to an emergency cesarean section. Methods Prospective cohort study in 980 women (> 34 weeks gestation) with a singleton fetus in breech presentation....
Article
Full-text available
Background: There is an ongoing discussion on the rising CS rate worldwide. Suboptimal guideline adherence may be an important contributor to this rise. Before improvement of care can be established, optimal CS care in different settings has to be defined. This study aimed to develop and measure quality indicators to determine guideline adherence...
Article
Full-text available
Background: The increasing number of operative deliveries is a topic of major concern in modern obstetrics. Maternal thyroid function is of known influence on many obstetric parameters. Our objective was to investigate a possible relation between maternal thyroid function, and operative deliveries. Secondary aim was to explore whether thyroid func...
Article
Objective Small for gestational age (SGA) newborns constitute still a major cause of perinatal morbidity and mortality. Overt thyroid disease is a known cause of preterm birth and low birth weight but in its untreated condition it is rare today. In the present study we investigated the possible relation between maternal thyroid function assessed in...
Article
Despite the many efforts to study the (patho)physiology of meconium release before delivery, it still remains an indistinct subject. Some studies have reported a relationship between hypoxia and MSAF, whilst others have not. The most common association found however, is between MSAF and the term of gestation. MEDLINE, EMBASE and the Cochrane librar...
Article
Maternal thyroid dysfunction is of known influence on pregnancies in the preterm period. However little is known about its effect on term and post term pregnancies. Meconium stained amniotic fluid (MSAF) is known to occur preferentially in (post)term pregnancies. To assess a possible independent relation between maternal thyroid function and MSAF....
Article
Objective: To develop a multivariable prognostic model for the risk of preterm delivery in women with multiple pregnancy that includes cervical length measurement at 16 to 21 weeks' gestation and other variables. Methods: We used data from a previous randomized trial. We assessed the association between maternal and pregnancy characteristics inc...
Article
Full-text available
Objective was to determine whether fear for external cephalic version (ECV) and depression are associated with the success rate of ECV in women with a breech presentation at term. Prospective study conducted in the Catharina Hospital Eindhoven between October 2007 and May 2012. Participants fulfilled The Edinburgh Depression Scale (EDS) questionnai...
Article
Objective: To compare the obstetric outcomes of pregnant women after successful external cephalic version (ECV) (cases) with a large group of pregnant women with a spontaneously occurring cephalic fetal position at delivery (controls). Methods: We conducted a retrospective matched cohort study in a teaching hospital in the Netherlands. Delivery...
Article
Pregnancies complicated by intrauterine growth restriction (IUGR) are at increased risk for neonatal morbidity and mortality. The Dutch nationwide disproportionate intrauterine growth intervention trial at term (DIGITAT trial) showed that induction of labour and expectant monitoring were comparable with respect to composite adverse neonatal outcome...
Article
Objective: To investigate the impact on obstetric outcome in nulliparous women of changing labour management from an expectant approach to proactive support of labour. Methods: We conducted a retrospective cohort study in a teaching hospital in the Netherlands among 858 women ≥ 37 weeks' gestation with a singleton fetus in cephalic position and...
Article
Full-text available
Background: This study describes variables related to women's prelabour preference for epidural analgesia (PEA) in two neighbouring countries with a comparable socio-economic and cultural background. Methods: Dutch women in midwifery (n = 164) or obstetrical care (n = 162), and Belgian women (n = 188) of ≥36 weeks gestation with a singleton in c...
Article
Objective: To evaluate the difference in thickness of the anterior vaginal wall removed after different surgical dissecting techniques of anterior colporrhaphy. Study design: In patients undergoing primary anterior colporrhaphy, trimmed vaginal tissue was taken following different surgical techniques of vaginal wall dissection. Tissues were pres...
Article
Iron deficiency is a frequent cause of anaemia in pregnancy and often results in fatigue and malaise. To prevent complications during labour, timely iron suppletion is important. A 30-year-old multiparous female presented at the outpatient clinic in her 38th week of this pregnancy because of fatigue and lightheadedness. She had been prescribed oral...
Article
Previous studies on singleton pregnancies have indicated that progestogens may reduce the rate of cervical shortening during pregnancy. The aim of this study was to investigate whether treatment with 17-alpha hydroxyprogesterone caproate (17-OHPC) has an effect on cervical shortening in twin pregnancies. This was a secondary analysis of patients wh...
Article
To estimate whether administration of 17α-hydroxyprogesterone caproate can prevent neonatal morbidity in multiple pregnancies by reducing the preterm birth rate. We conducted a multicenter, double-blind, placebo-controlled randomized trial in 55 obstetric clinics in the Netherlands. Women with a multiple pregnancy were randomized to weekly injectio...
Article
To study the relationship between maternal thyroid function at each pregnancy trimester and neonatal screening results. Overt maternal thyroid dysfunction during gestation is associated with poor neonatal thyroid function. However, research on the relationship between suboptimal maternal thyroid function (assessed at three trimesters) and neonatal...
Article
Umbilical cords of fetuses in breech presentation differ in length and coiling from their cephalic counterparts and it might be hypothesised that these cord characteristics may in turn affect ECV outcome. To investigate the relation between umbilical cord characteristics and the outcome of external cephalic version (ECV). Prospective cohort study....
Article
Full-text available
To investigate the relation between maternal thyroid function and the outcome of external cephalic version (ECV) in breech presentation. Prospective cohort study in 141 women (≥ 35 weeks gestation) with a singleton fetus in breech. Blood samples for assessing thyroid function were taken prior to ECV. Main outcome measure was the relation between ma...
Data
ECV technique. ECV is performed by two experienced obstetricians working closely thogether: the hands of one obstetrician concentrate on the breech, while the other's concentrate on the fetal head, with manipulation being consecutive rather than simultaneous and changing from a "pull"movement into a "push"movement. The procedure is monitored by a t...
Article
Full-text available
To compare the effect of induction of labour with a policy of expectant monitoring for intrauterine growth restriction near term. Multicentre randomised equivalence trial (the Disproportionate Intrauterine Growth Intervention Trial At Term (DIGITAT)). Eight academic and 44 non-academic hospitals in the Netherlands between November 2004 and November...
Article
To study the relationship between maternal thyrotrophin (TSH) and breech presentation at term. Combined data sets of two prospective studies to obtain adequate epidemiological power. One thousand and fifty-eight healthy pregnant women (58 breech, 1000 cephalic) and 131 women who presented in breech at an obstetrical outpatient clinic. Maternal thyr...
Article
To investigate the effect of implementation of a number of process policy guidelines (protocol), on the success rate of external cephalic version (ECV) for breech presentation. Prospective study. During a 3-year period (2004-2006) a standardized protocol for an ECV consultation was developed, evaluated and adapted. After implementing this modified...
Article
To study the relationship between suboptimal maternal thyroid function during gestation and breech presentation at term. Prospective follow-up study during three trimesters of gestation. A total of 1058 Dutch Caucasian healthy pregnant women were prospectively followed from 12 weeks gestation until term (>or=37 weeks) delivery. Maternal thyroid par...
Article
Full-text available
Intrauterine infection is suggested to cause perinatal brain white matter injury. In the current study, we evaluated whether S100B, a brain damage marker, may be also assessed in maternal bloodstream after white matter injury induced by fetal intravenous application of lypopolisaccharide (LPS) endotoxin. Fourteen fetal sheeps were chronically cathe...
Article
Identification of determinants affecting the outcome of external cephalic version (ECV) in breech presentation, and investigation of the impact of ECV--performed according to a standardized protocol in an outpatient clinic--on the mode of delivery. Retrospective analysis. In 2003 a standardized protocol of ECV was developed in the outpatient clinic...
Chapter
Full-text available
There is a growing body of evidence from clinical and epidemiologic studies that in utero exposure to infection plays an important role in the genesis of fetal or neonatal injury leading to cerebral palsy and chronic lung disease. Thus, after chorioamnionitis the incidence of immature neonates with periventricular white matter damage and periventri...
Chapter
There is a growing body of evidence from clinical and epidemiologic studies that in utero exposure to infection plays an important role in the genesis of fetal or neonatal injury leading to cerebral palsy and chronic lung disease. Thus, after chorioamnionitis the incidence of immature neonates with periventricular white matter damage and periventri...
Article
Fewer caesarean sections for breech presentation following external cephalic version according to a protocol in a special office visit Objective. Identification of determinants affecting the outcome of external cephalic version (ECV) in breech presentation, and investigation of the impact of ECV – performed according to a standardized protocol in a...
Article
Full-text available
15% of multiple pregnancies ends in a preterm delivery, which can lead to mortality and severe long term neonatal morbidity. At present, no generally accepted strategy for the prevention of preterm birth in multiple pregnancies exists. Prophylactic administration of 17-alpha hydroxyprogesterone caproate (17OHPC) has proven to be effective in the pr...
Article
To study endotoxin induced changes in pulmonary blood flow during normoxia and hypoxia and analyzed the role of nitric oxide (NO) and endothelin (ET) in this process. Twenty-seven fetal sheep were chronically instrumented at 107+/-1 days (term is 147 days). Experiments were performed 3 days after surgery. Fetuses were randomized into four groups. G...
Article
Intrauterine infection is suggested to cause perinatal brain white matter injury. The aim of the present study was to clarify, whether intravenous application of endotoxin results in neuropathological findings and increased blood levels of the S100B protein, which is a consolidated marker of brain injury. Twenty-one fetal sheep were chronically cat...
Article
Full-text available
To investigate the role of nitric oxide in the process of circulatory decentralization during fetal hypoxemia. Fifteen sheep with singleton pregnancies were chronically instrumented at 107 days of gestation (term is 147 days). Three days later, 8 of the fetuses received nitro-L-arginine methyl ester (L-NAME), an inhibitor of nitric oxide synthesis....
Article
Full-text available
In the present study we examined the effects of low-dose endotoxin (lipopolysaccharides, LPS) on continuously recorded umbilical blood flow. Twenty fetal sheep were catheterized at a gestational age of 107 +/- 1 days. A flow probe was placed around either the common umbilical artery or one single umbilical artery. Three days later fetuses received...
Article
Full-text available
There is a growing body of evidence from clinical and epidemiologic studies that in utero exposure to infection plays an important role in the genesis of fetal or neonatal injury leading to cerebral palsy and chronic lung disease. Thus, after chorioamnionitis the incidence of immature neonates with periventricular white matter damage and periventri...
Article
Full-text available
The role of nitric oxide in control of fetal cardiovascular functions and of cerebral blood flow during normoxia and acute hypoxia is only partially known. We studied the effects of nitric oxide synthase inhibition on the distribution of cardiac output in preterm sheep using N(omega)-nitro-L-arginine methyl ester (L-NAME). Thirteen fetal sheep were...
Article
In a male foetus with a giant teratoma of the neck, a so-called 'ex utero intra partum treatment' (EXIT) was used to create a safe airway during birth by caesarean section. The child was orotracheally intubated with intact placental circulation. Nine minutes after the start of the procedure, a safe airway was created and the umbilical cord was liga...
Article
Perinatal brain damage is associated not only with hypoxic-ischemic insults but also with intrauterine inflammation. A combination of antenatal inflammation and asphyxia increases the risk of cerebral palsy >70 times. The aim of the present study was to determine the effect of intracisternal (i.c.) administration of endotoxin [lipopolysaccharides (...
Article
Full-text available
Perinatal brain damage is associated not only with hypoxic-ischemic insults but also with intrauterine inflammation. A combination of antenatal inflammation and asphyxia increases the risk of cerebral palsy >70 times. The aim of the present study was to determine the effect of intracisternal (i.c.) administration of endotoxin [lipopolysaccharides (...
Article
Large fetal neck masses can cause airway obstructions with potential fetal demise after delivery. The relationship of the neck mass to airway structures can be defined prenatally with ultrasound and magnetic resonance imaging (MRI). The ex utero intrapartum treatment (EXIT) procedure can be used to obtain a fetal airway while feto-maternal circulat...
Article
Full-text available
The purpose of the present study was to determine whether endotoxins (lipopolysaccharides, LPS) affect the fetal cardiovascular system in a way likely to cause brain damage. Thirteen fetal sheep were chronically instrumented at a mean gestational age of 107 +/- 1 days. After control measurements of organ blood flow (microsphere method), blood gases...
Article
To examine the effect of repetitive total umbilical cord occlusions on electrocortical brain activity as measured by cerebral function analyzing monitoring (CAFM) and the histologic outcome in immature sheep fetuses. We performed brief repeated total umbilical cord occlusions, two every 5 minutes, in 12 immature sheep fetuses (at 90 days of gestati...
Article
To evaluate the relationship of the PR interval and fetal heart rate during repetitive umbilical cord occlusions in immature sheep fetuses. In seven chronically cannulated immature sheep fetuses [gestational age 90.6 days (mean)], we analyzed continuous fetal electrocardiogram recordings during repetitive cord occlusions for 2 out of every 5 min un...
Article
To describe the changes in fetal heart rate and mean arterial pressure during repetitive total umbilical cord occlusions in immature sheep fetuses, resulting in severe asphyxia or fetal death. To describe the relationship between these changes and concurrent changes in acid-base status. We performed brief repeated total umbilical cord occlusions, t...
Article
The estimated incidence in the Netherlands of serious previable twin-to-twin transfusion syndrome is 50-100 cases per year. The polyhydramnion-oligohydramnion sequence is the most prominent feature. Prognosis without treatment is dismal: previable preterm birth. Risk of serious morbidity in the surviving twin in case of foetal demise of the other i...
Article
To investigate the effect of total umbilical cord occlusion on cerebral arteriovenous difference for nitrite (a stable end product of nitric oxide) and neuronal outcome. The cord was totally occluded for 10 minutes in 14 late-gestation (gestational age 113-120 days) chronically instrumented fetal sheep. Arterial (carotid artery) and venous (superio...
Article
A patient presented with intrauterine fetal death at 21 weeks. A Candida vaginitis was treated at 18 weeks of gestation. Fatal fetal Candida sepsis caused by Candida albicans can occur in the absence of known risk factors such as prolonged rupture of membranes, the presence of an intrauterine contraceptive device or cervical cerclage.
Article
To study the relationship between arterial PCO2 (PaCO2) and transcutaneous PCO2 (tcPCO2) intermittent 2-min total umbilical cord occlusions were performed with a 3-min interval (n = 12) in 5 fetal sheep, tcPCO2 was measured continuously. Arterial acid-base balance was analyzed at the end of occlusion periods and at the end of occlusion intervals. D...
Article
No consensus exists concerning the influence of head position and head position change on body posture and motility. Especially the existence of an asymmetric tonic neck reflex (ATNR) in full-term newborns is an issue of discussion. Three-hour video recordings were made of 15 full-term appropriate for gestational age (AGA) and 15 full-term small fo...
Article
Our purpose was to determine whether neuronal damage results after total umbilical cord occlusion of increasing duration in midgestation fetal sheep. We performed total umbilical cord occlusion during 10 (n = 11), 15 (n = 8), or 20 (n = 4) minutes in chronically instrumented midgestation fetal sheep. Nine fetuses served as sham controls. During the...
Article
In an acute fetal lamb model the relation between arterial PCO2 (PaCO2), transcutaneous PCO2 (tcPCO2) and pH was studied at different conditions of stress. Occlusion of the maternal common iliac artery for 8 min, umbilical cord obstruction for 5 min and placental embolization were performed subsequently, every time with an interval of 1 h for fetal...
Article
The essential fatty acid (EFA) status of full-term infants born after an uneventful, singleton pregnancy has been reported to be marginal. If this low EFA status is caused by a limiting maternal EFA supply, the higher total fetal EFA demand associated with a multiple pregnancy would result in an even lower EFA status of the infants born after a mul...
Article
In view of the importance of long-chain polyunsaturated fatty acids (LCP) for growth and development of fetal and infant neural tissue, the influence of the dietary n-3 and n-6 LCP intake on the LCP status of forty-three preterm infants (birth weight < 1800 g) was studied. Thirty-one formula-fed infants were randomly assigned to receive a conventio...