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Article ; Online: The contribution of suicide to maternal mortality: A nationwide population-based cohort study.

Lommerse, Kinke M / Mérelle, Saskia / Rietveld, Anna L / Berkelmans, Guus / van den Akker, Thomas

BJOG : an international journal of obstetrics and gynaecology

2024

Abstract: Objective: To identify the incidence and characteristics of maternal suicide.: Design: Nationwide population-based cohort study.: Setting: The Netherlands, 2006-2020.: Population: Women who died during pregnancy or within 1 year postpartum, and ...

Abstract	Objective: To identify the incidence and characteristics of maternal suicide. Design: Nationwide population-based cohort study. Setting: The Netherlands, 2006-2020. Population: Women who died during pregnancy or within 1 year postpartum, and a reference population of women aged 25-45 years. Methods: The Cause of Death Register and Medical Birth Register were linked to identify women who died within 1 year postpartum. Data were combined with deaths reported to the Audit Committee for Maternal Mortality and Morbidity (ACMMM), which performs confidential enquiries. Maternal suicides were compared with a previous period (1996-2005). Risk factors were obtained by combining vital statistics databases. Main outcome measures: Comparison of incidence and proportion of maternal suicides among all maternal deaths over time, sociodemographic and patient-related risk factors and underreporting of postpartum suicides. Results: The maternal suicide rate remained stable with 68 deaths: 2.6 per 100 000 live births in 2006-2020 versus 2.5 per 100 000 in 1996-2005. The proportion of suicides among all maternal deaths increased from 18% to 28%. Most suicides occurred throughout the first year postpartum (64/68); 34 (53%) of the women who died by suicide postpartum were primiparous. Compared with mid-level, low educational level was a risk factor (odds ratio 4.2, 95% confidence interval 2.3-7.9). Of 20 women reported to the ACMMM, 11 (55%) had a psychiatric history and 13 (65%) were in psychiatric treatment at the time of death. Underreporting to ACMMM was 78%. Conclusions: Although the overall maternal mortality ratio declined, maternal suicides did not and are now the leading cause of maternal mortality if late deaths up to 1 year postpartum are included. Data collection and analysis of suicides must improve.
Language	English
Publishing date	2024-02-12
Publishing country	England
Document type	Journal Article
ZDB-ID	2000931-8
ISSN	1471-0528 ; 0306-5456 ; 1470-0328
ISSN (online)	1471-0528
ISSN	0306-5456 ; 1470-0328
DOI	10.1111/1471-0528.17784
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Article ; Online: Lessons learned in cases of late preterm mortality in the Netherlands: Results from nationwide perinatal audits, a mixed method study.

Baauw, Ludovic / Rosman, Ageeth N / van den Akker, Thomas H

European journal of obstetrics & gynecology and reproductive biology: X

2023 Volume 17, Page(s) 100179

Abstract: Objective: Assess improvable care factors in late preterm mortality, defined as death of a child during labour or in the first 28 days thereafter between 32 + 0 and 36 + 6 weeks gestation, in the Netherlands.: Design: Perinatal audit has been ... ...

Abstract	Objective: Assess improvable care factors in late preterm mortality, defined as death of a child during labour or in the first 28 days thereafter between 32 + 0 and 36 + 6 weeks gestation, in the Netherlands. Design: Perinatal audit has been coordinated and supported at the national level, with selection of nationwide audit themes, and audit sessions are performed at the local level across the country as multidisciplinary meetings with primary and secondary level health care professionals, organised in local perinatal cooperation units. In 2017-2019, late preterm mortality was such a theme. We compiled and systematically categorised all improvable care factors formulated during local audit meetings in a national perinatal audit database. Results: In total, 27 cases were discussed in local perinatal audits and analysed locally and at the national level. Altogether, 52 improvable care factors were identified. Most identified improvable care factors concerned inadequate foetal monitoring by cardiotocography during labour, factors related to care organisation, particularly unclarity around local assigning of responsibilities and work procedures, and poor communication between involved health care professionals especially in transfer of care. Conclusion: Several critical improvable care factors were identified through nationwide perinatal audit of late preterm deaths in the Netherlands.
Language	English
Publishing date	2023-02-03
Publishing country	Netherlands
Document type	Journal Article
ISSN	2590-1613
ISSN (online)	2590-1613
DOI	10.1016/j.eurox.2023.100179
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Article ; Online: Variations over time in mode of birth and perinatal outcomes in women with one previous cesarean in the Netherlands: A 20-year population-based study.

Koorn, Ian / Vis, Linda C / Verschueren, Kim J C / Rosman, Ageeth N / van den Akker, Thomas

Birth (Berkeley, Calif.)

2023

Abstract: Background: Globally, cesarean birth rates are rising, and while it can be a lifesaving procedure, cesarean birth is also associated with increased maternal and perinatal risks. This study aims to describe changes over time about the mode of birth and ... ...

Abstract	Background: Globally, cesarean birth rates are rising, and while it can be a lifesaving procedure, cesarean birth is also associated with increased maternal and perinatal risks. This study aims to describe changes over time about the mode of birth and perinatal outcomes in second-pregnancy women with one previous cesarean birth in the Netherlands over the past 20 years. Methods: We conducted a nationwide, population-based study using the Dutch perinatal registry. The mode of birth (intended vaginal birth after cesarean (VBAC) compared with planned cesarean birth) was assessed in all women with one previous cesarean birth and no prior vaginal birth who gave birth to a term singleton in cephalic presentation between 2000 and 2019 in the Netherlands (n = 143,146). The reported outcomes include the trend of intended VBAC, VBAC success rate, and adverse perinatal outcomes (perinatal mortality up to 7 days, low Apgar score at 5 min, asphyxia, and neonatal intensive care unit admission ≥24 h). Results: Intended VBAC decreased by 21.5% in women with one previous cesarean birth and no prior vaginal birth, from 77.2% in 2000 to 55.7% in 2019, with a marked deceleration from 2009 onwards. The VBAC success rate dropped gradually, from 71.0% to 65.3%, across the same time period. Overall, the cesarean birth rate (planned and unplanned) increased from 45.2% to 63.6%. Adverse perinatal outcomes were higher in women intending VBAC compared with those planning a cesarean birth. Perinatal mortality initially decreased but remained stable from 2009 onwards, with only minimal differences between both modes of birth. Conclusions: In the Netherlands, the proportion of women intending VBAC after one previous cesarean birth and no prior vaginal birth has decreased markedly. Particularly from 2009 onwards, this decrease was not accompanied by a synchronous reduction in perinatal mortality.
Language	English
Publishing date	2023-12-01
Publishing country	United States
Document type	Journal Article
ZDB-ID	604869-9
ISSN	1523-536X ; 0730-7659
ISSN (online)	1523-536X
ISSN	0730-7659
DOI	10.1111/birt.12803
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Article: Compliance with maternal sepsis guidelines in a tertiary hospital in the Netherlands.

de Vries, Baukje S / Verschueren, Kim J C / Jansen, Sophie / Bekker, Vincent / Veenhof, Marieke B / van den Akker, Thomas

Hospital practice (1995)

2024 , Page(s) 1–5

Abstract: Objectives: Sepsis is a common cause of maternal mortality and morbidity. Early detection and rapid management are essential. In this study, we evaluate the compliance with the implemented maternity-specific Early Warning Score (EWS), Rapid Response ... ...

Abstract	Objectives: Sepsis is a common cause of maternal mortality and morbidity. Early detection and rapid management are essential. In this study, we evaluate the compliance with the implemented maternity-specific Early Warning Score (EWS), Rapid Response Team (RRT) protocol and the Surviving Sepsis Campaign (SSC) Hour-1 Bundle in a tertiary hospital in the Netherlands. Methods: We performed a retrospective patient chart review from July 2019 to June 2020 at the Leiden University Medical Centre. We included women who received therapeutic antibiotics and were admitted for at least 24 hours. Results: We included 240 women: ten were admitted twice and one woman three times, comprising 252 admissions. A clinical diagnosis of sepsis was made in 22 women. The EWS was used in 29% ( Conclusion: The adherence to the maternity-specific EWS and the SSC Hour-1 bundle was insufficient, even within this tertiary setting in a high-income country.
Language	English
Publishing date	2024-02-26
Publishing country	England
Document type	Journal Article
ZDB-ID	2570453-9
ISSN	2377-1003 ; 2154-8331 ; 8750-2836
ISSN (online)	2377-1003
ISSN	2154-8331 ; 8750-2836
DOI	10.1080/21548331.2024.2320068
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Article ; Online: Etniciteit als prognostische factor bij vroeggeboorte.

De Proost, Lien / Van den Akker, Thomas / Haalboom, Floor / Verweij, E Joanne

Nederlands tijdschrift voor geneeskunde

2023 Volume 167

Abstract: A substantial body of research suggests that 'race' or 'ethnicity' may impact the prognosis following extreme preterm birth. However, the definitions of these classifications remain unclear. Often, there is an unsupported assumption of biological ... ...

Title translation	Ethnicity as a prognostic factor in extreme preterm birth.
Abstract	A substantial body of research suggests that 'race' or 'ethnicity' may impact the prognosis following extreme preterm birth. However, the definitions of these classifications remain unclear. Often, there is an unsupported assumption of biological differences among various ethnic groups. Moreover, there is a lack of transparency in how researchers utilize these categories and determine individual affiliations, resulting in inconsistent findings in the literature. The primary aim of considering and discussing prognostic factors is to enhance decision-making at the limit of viability. Incorporating ethnicity as a prognostic factor, however, does not advance this objective. Instead, it may have adverse effects on families experiencing extreme preterm birth. This article contends, therefore, that the implications of including ethnicity as a prognostic factor in guidelines, discussions, or decision-making for extreme preterm birth deserve careful consideration.
MeSH term(s)	Female ; Infant, Newborn ; Humans ; Ethnicity ; Premature Birth ; Prognosis
Language	Dutch
Publishing date	2023-10-04
Publishing country	Netherlands
Document type	English Abstract ; Journal Article
ZDB-ID	82073-8
ISSN	1876-8784 ; 0028-2162
ISSN (online)	1876-8784
ISSN	0028-2162
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Article ; Online: Vacuum extraction for non-rotational and rotational assisted vaginal birth.

van den Akker, Thomas

Best practice & research. Clinical obstetrics & gynaecology

2018 Volume 56, Page(s) 47–54

Abstract: Vacuum-assisted birth is a safe mode of birth in the presence of a skilled provider. Vacuum extraction can avoid prolonged second stage of labour, birth asphyxia in the presence of foetal distress or maternal pushing where contraindicated. Vacuum- ... ...

Abstract	Vacuum-assisted birth is a safe mode of birth in the presence of a skilled provider. Vacuum extraction can avoid prolonged second stage of labour, birth asphyxia in the presence of foetal distress or maternal pushing where contraindicated. Vacuum-assisted births - particularly those in midpelvic rotational births - have been increasingly traded for caesarean births, although the latter are generally associated with potentially a greater risk to women and (future) children. In this article, (contra)indications and the basics of vacuum technique are elaborated. A specific section is dedicated to vacuum extraction for rotational birth. If these techniques are known, trained and practiced by obstetric care givers, then vacuum extraction has tremendous potential to make childbirth safer.
MeSH term(s)	Contraindications, Procedure ; Dystocia/therapy ; Female ; Humans ; Labor Stage, Second ; Pregnancy ; Vacuum Extraction, Obstetrical/adverse effects ; Vacuum Extraction, Obstetrical/methods ; Version, Fetal
Language	English
Publishing date	2018-12-13
Publishing country	Netherlands
Document type	Journal Article ; Review
ZDB-ID	2050090-7
ISSN	1532-1932 ; 1521-6934
ISSN (online)	1532-1932
ISSN	1521-6934
DOI	10.1016/j.bpobgyn.2018.12.002
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Article ; Online: Quality of Maternal Death Documentation in Afghanistan: A Retrospective Health Facility Record Review.

Maruf, Farzana / Tappis, Hannah / Stekelenburg, Jelle / van den Akker, Thomas

Frontiers in global women's health

2021 Volume 2, Page(s) 610578

Abstract: Objectives: ...

Abstract	Objectives:
Language	English
Publishing date	2021-03-17
Publishing country	Switzerland
Document type	Journal Article
ISSN	2673-5059
ISSN (online)	2673-5059
DOI	10.3389/fgwh.2021.610578
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Article ; Online: "Too much, too late": data on stillbirths to improve interpretation of caesarean section rates.

Zethof, Siem / Christou, Aliki / Benova, Lenka / van Roosmalen, Jos / van den Akker, Thomas

Bulletin of the World Health Organization

2022 Volume 100, Issue 4, Page(s) 289–291

MeSH term(s)	Cesarean Section ; Female ; Humans ; Pregnancy ; Stillbirth/epidemiology
Language	English
Publishing date	2022-02-28
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	80213-x
ISSN	1564-0604 ; 0042-9686 ; 0366-4996 ; 0510-8659
ISSN (online)	1564-0604
ISSN	0042-9686 ; 0366-4996 ; 0510-8659
DOI	10.2471/BLT.21.287539
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Article ; Online: Establishing the Ethiopian Obstetric Surveillance System for Monitoring Maternal Outcomes in Eastern Ethiopia: A Pilot Study.

Tura, Abera Kenay / Girma, Sagni / Dessie, Yadeta / Bekele, Delayehu / Stekelenburg, Jelle / van den Akker, Thomas / Knight, Marian

Global health, science and practice

2023 Volume 11, Issue 2

Abstract: Background: Although the majority of maternal deaths and complications occur in low-resource settings, almost all existing strong registration and confidential enquiry systems are found in high-resource settings. We developed and piloted the Ethiopian ... ...

Abstract	Background: Although the majority of maternal deaths and complications occur in low-resource settings, almost all existing strong registration and confidential enquiry systems are found in high-resource settings. We developed and piloted the Ethiopian Obstetric Surveillance System (EthOSS), based on the successful United Kingdom Obstetric Surveillance System (UKOSS) methodology, in 3 regions in Ethiopia to improve ongoing surveillance and tracking of maternal morbidities and deaths, as well as confidential enquiry, compared to the currently used maternal death surveillance and response program in Ethiopia. Methods: We launched the EthOSS monthly case notification system in 13 hospitals in eastern Ethiopia in April 2021. Study participants included women admitted to the hospitals from April to September 2021 with major adverse obstetric conditions during pregnancy, childbirth, or within 42 days of termination of pregnancy. Designated clinicians at the hospitals used a simple online system to report the number of cases and maternal deaths monthly to the EthOSS team. We present findings on the incidence and case fatality rates for adverse conditions included in the EthOSS. Results: Over the 6-month pilot period, 904 women with at least 1 EthOSS condition were included in the study, of whom 10 died (case fatality rate, 1.1%). Almost half (46.6%, 421/904) sustained major obstetric hemorrhage, 38.7% (350/904) severe anemia, 29.5% (267/904) eclampsia, 8.8% (80/904) sepsis, and 2.2% (20/904) uterine rupture. To enable care improvement alongside surveillance, the local committee received training on confidential enquiry into maternal deaths from internal and external experts. Conclusions: In this facility-based project, data on severe adverse obstetric conditions were captured through voluntary reporting by clinicians. Further analysis is essential to assess the robustness of these data, and confidential enquiry into maternal deaths for specific cases is planned to investigate the appropriateness of care.
MeSH term(s)	Pregnancy ; Female ; Humans ; Pregnancy Complications/epidemiology ; Maternal Death ; Pilot Projects ; Ethiopia/epidemiology ; Obstetric Labor Complications/epidemiology ; Maternal Mortality
Language	English
Publishing date	2023-04-28
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2710875-2
ISSN	2169-575X ; 2169-575X
ISSN (online)	2169-575X
ISSN	2169-575X
DOI	10.9745/GHSP-D-22-00281
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Article ; Online: Facilitators and barriers of implementation of routine postnatal care guidelines for women: A systematic scoping review using critical interpretive synthesis.

Beňová, Lenka / Semaan, Aline / Portela, Anayda / Bonet, Mercedes / van den Akker, Thomas / Pembe, Andrea B / Moran, Allisyn / Duclos, Diane

Journal of global health

2023 Volume 13, Page(s) 4176

Abstract: Background: Postnatal care (PNC) has the potential to prevent a substantial burden of maternal and newborn morbidity and mortality. This scoping review aimed to identify and synthesise themes related to facilitators and barriers of implementation of ... ...

Abstract	Background: Postnatal care (PNC) has the potential to prevent a substantial burden of maternal and newborn morbidity and mortality. This scoping review aimed to identify and synthesise themes related to facilitators and barriers of implementation of guidelines on routine PNC for women (postpartum care) in all settings. Methods: This is a scoping review guided by the standard principles of Arksey & O'Malley's framework. We used the critical interpretive synthesis method to synthesise the whole body of evidence. We searched four databases (Medline, Embase, Global Health, CINAHL Plus) using a combination of search terms comprising four key concepts: postnatal care, routine care, guidelines and implementation. No restrictions on country or language of publication were applied. We excluded studies not presenting findings about PNC for women. We thematically charted the themes of studies included based on title and abstract screening. All studies included after full text screening were described and their results synthesised using the socio-ecological model framework. We did not conduct a risk of bias analysis or quality assessment of included studies. Results: We identified a total of 8692 unique records and included 43 studies which identified facilitators and barriers to implementing routine guidelines in provision of PNC to women. Three quarters of studies pertained to PNC provision in high-income countries. Specific facilitators and barriers were identified and thematically presented based on whether they affect the provision of PNC or the intersection between provision of PNC and its use by women and families. We applied a critical global health lens to synthesise three constructs in the literature: finding a balance between standardisation and individualisation of PNC, the fragmented PNC provision landscape complicating the experiences of women with intersecting vulnerabilities, and the heavy reliance on the short postpartum period as an opportunity to educate and retain women and newborns in the health system. Conclusions: This interpretive synthesis of evidence shows that the fragmented and narrow nature of PNC provision presents specific challenges to developing, adapting and implementing routine PNC guidelines. This results in a lack of linkages to social support and services, fails to address intersecting vulnerabilities and inequities among women, and negatively influences care seeking. There is a lack of evidence on how processes of individualising PNC provision can be applied in practice to support health workers in providing woman-centered PNC in various global settings. Registration: https://www.protocols.io/private/C99DA688881F11EBB4690A58A9FEAC02.
MeSH term(s)	Pregnancy ; Female ; Humans ; Infant, Newborn ; Postnatal Care ; Postpartum Period ; Patient Acceptance of Health Care ; Health Personnel ; Social Support
Language	English
Publishing date	2023-11-24
Publishing country	Scotland
Document type	Systematic Review ; Journal Article
ZDB-ID	2741629-X
ISSN	2047-2986 ; 2047-2986
ISSN (online)	2047-2986
ISSN	2047-2986
DOI	10.7189/jogh.13.04176
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