The impact of four recent Consortium trials on obstetric management and the occurrence of maternal and neonatal complications in the Netherlands

Sonnaville, C. de (Catherine) (2016) The impact of four recent Consortium trials on obstetric management and the occurrence of maternal and neonatal complications in the Netherlands. thesis, Medicine.

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Abstract

BACKGROUND Since there was lack of consensus regarding the optimal treatment of various complicated pregnancies, the HYPITAT I and II, DIGITAT and PPROMEXIL Consortium trials were performed in the Netherlands between 2004 and 2013, investigating whether induction of labour reduces severe maternal and neonatal morbidity compared with expectant monitoring in women with various complicated pregnancies at different gestational ages. AIM We aim to examine the impact of the trial results on obstetric management and subsequent incidence of maternal and neonatal outcomes in the Netherlands. METHODS We performed a retrospective cohort study by analyzing aggregate data from the National Dutch Perinatal Registry from 2000 to 2014. We compared the outcomes of the period before trial with the period after trial for each trial separately. We studied trends in proportions of „onset of labour‟, in both teaching and non-teaching hospitals, „mode of delivery‟ and the occurrence of maternal and neonatal complications in the total group of pregnant women and in each subgroup of patients with complicated pregnancies delivered in secondary and tertiary care hospitals in the Netherlands. RESULTS The rate of inductions changed significantly after each trial, often associated with a positive change in the rate of spontaneous vaginal deliveries. Besides that, the incidence of many maternal and neonatal complications has reduced over the years. Severe hypertension, perinatal death and maternal mortality showed the strongest reductions. We observed an overall increasing trend in induction from 20.6% in 2006 to 30.9% in 2012, more pronounced in term and post-term pregnancies. However, in recent years we observed a decrease, also in each patient population. Moreover, we observed an overall increased rate of spontaneous vaginal deliveries, decreased rate of instrumental vaginal deliveries and more or less stable low caesarean section rate over the years. CONCLUSIONS This study showed an improved quality of obstetric health care in the Netherlands between 2000 and 2014, which is reflected by a relevant reduction of maternal and neonatal morbidity and mortality in (various complicated) pregnancies. Besides that, this study has shown that new insights of complicated pregnancies due to the Consortium trial results had a substantive impact on obstetric management, mainly in teaching hospitals. Finally, it seems that the (consequences of) increasing medicalization of obstetric management in the Netherlands is less than expected.

Item Type:	Thesis (Thesis)
Supervisor name:	Faculty supervisor: and Groen, Dr. H.
Supervisor name:	External supervisor: and Pampus, Dr. M.G. van and Mol Prof. B.W. and Location: Department of Obstetrics and Gynaecology, OLVG
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 11:02
Last Modified:	25 Jun 2020 11:02
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/2210

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