Roolvink, M. (Manon) (2013) Perinatale sterfte in de voorgeschiedenis; invloed op het interpregnancy interval en op het handelen van de obstetrische zorgverleners. thesis, Medicine.
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Abstract
Background: A perinatal death in the previous pregnancy can influence the moment when the next pregnancy occurs and the obstetric management in this next pregnancy by the health care providers. Little is known about the length of the interpregnancy interval after perinatal death. In the literature, short interpregnancy intervals are associated with adverse perinatal outcomes. Knowledge is also scarce about the way in which health care providers act during this next pregnancy. The aim of this study is to determine the influence of a perinatal death on the interpregnancy interval and on the obstetric management in the next pregnancy. Methods: For this study 372 patients who experienced a previous perinatal death and became pregnant again were included in the cohort. In the reference group, 5175 patients with at least two live births were included. In both groups, the mean interpregnancy interval has been calculated. Information was gained about de neonates in both groups born in the next pregnancy. In addition, information about the number of ctg’s, ultrasound examinations and labor inductions in the next pregnancy was collected. A survey of seven cases was conducted with the nine gynecologists working at the hospital in Deventer, about their obstetric policy in pregnancies after a perinatal death. Results: The mean interpregnancy interval is significantly shorter after a perinatal death (13,4 (95% CI 11,4 – 15,4) months) then after a live birth (24,3 (95% CI 23,8 – 24,7) months). In the pregnancy following a perinatal death, the children are born after a significantly shorter gestational age compared to the children born in the pregnancies after a live birth (267,2 (SD 19,6) vs 278,2 (SD 12,5) days). There is no significant difference in the amount of dysmaturity and congenital anomalies of the neonates born in the next pregnancy. The incidence of a second perinatal death was 3.8%, which is a higher percentage than the incidence of perinatal death in the general Dutch population. After a perinatal death, there are significantly more inductions of labor (50,1%) compared to the amount of inductions after a live birth (31,9%). The gynecologists in the hospital in Deventer prefer to do more interventions and examinations in the pregnancy following a perinatal death, compared to pregnancies following a live birth. Also, they differ in opinion about the obstetric policy in these pregnancies. Conclusions: The interpregnancy interval after a perinatal death is almost twice as short as after a live birth. In our study, neonates born after a perinatal death have more adverse outcomes compared to the neonates born in the pregnancy after a live birth. After a perinatal death, we found more labor inductions. The gynecologists who work at the hospital in Deventer, prefer to do more interventions and examinations in the pregnancy following a perinatal death, even if this pregnancy develops without complications.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Linden, dr. P.J.Q. van der |
| Supervisor name: | Leeuw-Harmsen, drs. L. van der and Deventer Ziekenhuis |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:53 |
| Last Modified: | 25 Jun 2020 10:53 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/1411 |
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