Maternal mortality and serious maternal morbidity in Jehovah's witnesses in the Netherlands

Objective  To determine the risk of maternal mortality and serious maternal morbidity because of major obstetric haemorrhage in Jehovah's witnesses in the Netherlands.
Design  A retrospective study of case notes.
Setting  All tertiary care centres, general teaching hospitals and other general hospitals in the Netherlands.
Sample  All cases of maternal mortality in the Netherlands between 1983 and 2006 and all cases of serious maternal morbidity in the Netherlands between 2004 and 2006.
Methods  Study of case notes using two different nationwide enquiries over two different time periods.
Main outcome measures  Maternal mortality ratio (MMR) and risk of serious maternal mortality.
Results  The MMR for Jehovah's witnesses was 68 per 100 000 live births. We found a risk of 14 per 1000 for Jehovah's witnesses to experience serious maternal morbidity because of obstetric haemorrhage while the risk for the total pregnant population was 4.5 per 1000.
Conclusions  Women who are Jehovah's witnesses are at a six times increased risk for maternal death, at a 130 times increased risk for maternal death because of major obstetric haemorrhage and at a 3.1 times increased risk for serious maternal morbidity because of obstetric haemorrhage, compared to the general Dutch population.     

Morbid obesity: a risk factor for obstetric complications

In a primipara, 28 years of age and with a BMI of 44 kg/m2, a Zavanelli manoeuvre was performed. Due to uterine atony she had to undergo a hysterectomy. A multipara, 39 years of age and with a BMI of 66 kg/m2, experienced that her weight exceeded the limits of the beds and that local anaesthesia was hard to perform; she suffered from a lesion of the lumbosacral plexus caused by a shoulder dystocia. In the end, both mothers and their babies could go home in a moderate condition. Obesity is becoming more prevalent and brings with it an increase in obstetric risks. During pregnancy and delivery, morbidly obese patients should be monitored by a gynaecologist. Special interest should focus on screening for (gestational) diabetes, hypertension and foetal growth. Ultrasound may detect congenital malformations early; however, the sensitivity of ultrasound is lower in morbidly obese patients. When macrosomia is expected, a clear plan should be made regarding the mode of delivery. It is useful to make a treatment protocol for morbidly obese patients.     

Complications of the 2009 influenza A/H1N1 pandemic in pregnant women in The Netherlands: a national cohort study

The 2009 influenza A/H1N1 pandemic caused an increase in complications in pregnant women. To be well prepared for a next pandemic, we investigated the obstetric and maternal complications of this pandemic. In our national cohort of 59 pregnant women who were admitted to the hospital, no major complications apart from preterm birth and admission to the neonatal intensive care unit were observed. Although the small size of this study precludes us drawing any definitive conclusions, comparing our results with those in other countries suggests that the influenza A/H1N1 pandemic had a relatively benign course in pregnant women in The Netherlands.     

Amino acid metabolism in the human fetus at term: leucine, valine, and methionine kinetics

Human fetal metabolism is largely unexplored. Understanding how a healthy fetus achieves its fast growth rates could eventually play a pivotal role in improving future nutritional strategies for premature infants. To quantify specific fetal amino acid kinetics, eight healthy pregnant women received before elective cesarean section at term, continuous stable isotope infusions of the essential amino acids [1-13C,15N]leucine, [U-13C5]valine, and [1-13C]methionine. Umbilical blood was collected after birth and analyzed for enrichments and concentrations using mass spectrometry techniques. Fetuses showed considerable leucine, valine, and methionine uptake and high turnover rates. α-Ketoisocaproate, but not α-ketoisovalerate (the leucine and valine ketoacids, respectively), was transported at net rate from the fetus to the placenta. Especially, leucine and valine data suggested high oxidation rates, up to half of net uptake. This was supported by relatively low α-ketoisocaproate reamination rates to leucine. Our data suggest high protein breakdown and synthesis rates, comparable with, or even slightly higher than in premature infants. The relatively large uptakes of total leucine and valine carbon also suggest high fetal oxidation rates of these essential branched chain amino acids.