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Prof. dr. E. Pajkrt MD PhD

Position
Professor
Main activities
Patient care, Research
Specialisation
Fetal and Maternal Medicine
Focus of research

My research is based around the use of prenatal and obstetric ultrasound in the prevention of fetal and obstetric complications and improving neonatale outcome. Ultrasound is one of the most frequently used diagnostic tools in pregnancy. It is used in all trimesters of pregnancy and for a large number of different indications. The research line is focus around three major topics:

 

- Fetal and chromosomal anomalies

 

Since 1994 we have been studying the value of first trimester ultrasound in the AMC, including the value of nuchal translucency measurement in the detection of fetal chromosomal anomalies and structural anomalies, especially cardiac anomalies. Our fetal medicine unit was the first to implement nuchal translucency measurement in screening for Down syndrome and has made a major contribution to the introduction of  the first trimester combined test for all pregnant women in the Netherlands. In 2014 we were part of the implementation study (TRIDENT 1) of the Non-Invasive Prenatal Test in screening for trisomy 21/18/13 which had been designed and was being carried out by the Dutch National NIPT consortium (www.NIPTconsortium.nl). according to the rules of the Population Screening Act, and after positive advice had been given by the Health Council of the Netherlands. We are on the brink of starting the TRIDENT 2 an  implementation study, funded by the Ministry of Health, of NIPT as a first trier test. A license has been granted for three years (starting April 1, 2017) by the Ministry of Health. 

Moreover, we have been big advocates for the introduction of the 20 week anomaly scan to all pregnant women and have been offering this scan to our pregnant population since 2000. Once both the combined test and the second trimester anomaly scan were introduced in the Netherlands in 2007 the focus of research in the AMC has expanded to the evaluation of both first and second trimester ultrasound screening, including the validation of nationally used biometry and growth charts. In 2011 a grant was received to evaluate the effectiveness of the 20 week anomaly scan. Furthermore, the CAHAL collaboration (LUMC, VuMC and AMC) is conducting a large project to evaluate the effect of the introduction of prenatal screening on the detection of cardiac anomalies. In 2011 a National dating protocol was introduced in our country and our institute was granted money for the implementation. Another special interest has been the prenatal dysmorfology or the identification of genetic syndromes in utero.  

 

- Prevention of preterm birth

Since 2009, the focus of my research has widened to include the evaluation of ultrasound intervention in the prediction and prevention of obstetric complications such as preterm birth, pre-eclampsia, fetal growth restriction, uterine rupture, placental abruption, rupture of vasa previa and placenta accreta. Cervical length (CL) measured in the second trimester by transvaginal ultrasound, is inversely related to the risk of preterm birth and is currently one of the most accurate predictors. Measurement of the cervical length can be used to evaluate  strategies in order to prevent or treat threatening preterm birth. This research line started in 2009 with the TRIPLE P study evaluating the effectiveness of vaginal progesteron in the prevention of preterm birth in women with an asymptomatic short cervix during the 20 week scan. Recently we have finished two RCT's. The data of those trials are currently being analysed. The APOSTEL VI evaluated the effectiveness of a cervical pessary in the prevention of preterm birth in pregnant women after an episode of threatened preterm birth (i.e. contractions).  The PROMEXIL III trial evaluated if (repeated) abdominal amnioinfusion after very early PPROM (< 24 weeks' gestation) with associated oligohydramnios improves perinatal survival and prevents pylmonary hypoplasia an other neonatal morbidities. Currently our research group is conduction two RCT's to evaluate the best treatment strategy in the prevention of preterm birth. The QUADRUPLE P study aims to compare the effectiveness of vaginal progesteron and cervical pessary in women with singleton and multiple pregnancies and a short cervix. The PC study evaluates whether a cervical pessary can replace a cervical cerclage in women with at least one previous preterm birth and an indication for a primary or secondary cerclage in terms of effectiveness and costs. All above mentioned studies can be found at: www.studies-obsgyn.nl

- Prevention of obstetrical complications

We are conduction a large prospective cohort study, the LUS trial which aims to evaluate the accuracy of antenatal sonographical measurement of the lower uterine segment thickness in the prediction of the risk of uterine rupture during a trial of labour in women with a previous Caesarean section. Other prospective cohort studies are deeply inbedded in clinical care and evaluate the incidence of placental pathology and abnormal placentation.

 

 

 

 

Key publications
  • Kleinrouweler CE, Wiegerinck MMJ, Ris-Stalpers C, Bossuyt PMM, van der Post JAM, von Dadelszen P, Mol BWJ, Pajkrt E [Contributors: Mignini L, von Dadelszen P, Magee L, Sawchuck D, Gao E, Mol BW, Oude Rengerink K, Zamora J, Fox C, Daniels J, Khan KS, Thangaratinam S, Meads C]] , Accuracy of circulating placental growth factor, vascular endothelial growth factor, soluble fms-like tyrosine kinase 1 and soluble endoglin in the prediction of pre-eclampsia: a systematic review and meta-analysis. BJOG-INT J OBSTET GY 2012;119 (7):778-787 [PubMed]
  • Kok N, Wiersma IC, Opmeer BC, de Graaf IM, Mol BW, Pajkrt E, Sonographic measurement of lower uterine segment thickness to predict uterine rupture during a trial of labor in women with previous Cesarean section: a meta-analysis. ULTRASOUND OBST GYN 2013;42 (2):132-139 [PubMed]
  • Kleinrouweler CE, Bossuyt PMM, Thilaganathan B, Vollebregt KC, Arenas Ramírez J, Ohkuchi A, Deurloo KL, Macleod M, Diab AE, Wolf H, van der Post JAM, Mol BWJ, Pajkrt E, Value of adding second-trimester uterine artery Doppler to patient characteristics in identification of nulliparous women at increased risk for pre-eclampsia: an individual patient data meta-analysis. ULTRASOUND OBST GYN 2013;42 (3):257-267 [PubMed]
  • Voskamp BJ, Fleurke-Rozema H, Oude-Rengerink K, Snijders RJM, Bilardo CM, Mol BWJ, Pajkrt E, Relationship of isolated single umbilical artery to fetal growth, aneuploidy and perinatal mortality: systematic review and meta-analysis. ULTRASOUND OBST GYN 2013;42 (6):622-628 [PubMed]
  • Kleinrouweler CE, Kuijper CF, van Zalen-Sprock MM, Mathijssen IB, Bilardo CM, Pajkrt E, Characteristics and outcome and the omphalocele circumference/abdominal circumference ratio in prenatally diagnosed fetal omphalocele. FETAL DIAGN THER 2011;30 (1):60-69 [PubMed]
All Publications
Research programmes

The role of prenatal and obstetric ultrasound in the prevention of fetal and obstetric complications and improving neonatale outcome.

The focus of my research is on prenatal ultrasound interventions in the prediction and prevention of obstetric complications, placental pathology and fetal anomalies. This main research line can be divided in three topics:

- The evaluation of the best treatment strategy in the prevention of preterm birth. This research is being conducted within the Dutch Obstetric Consortium 2.0 and is part of the PROMPT initiative (PROspective Meta-analysis for Pessary Trials), an international collaboration embedded within the Global Obstetrics Network (GONet) that aims to perform a prospective individual patient data meta-analysis of pessary trials around the world.

- Evaluation of prenatal screening strategies for fetal chromosomal and structural anomalies in both the first and second trimester of pregnancy.

- The introduction of new screening strategies in the prevention of obstetric hemorrhage and placaental problems.

 

Faculty
Prof. dr. E. Pajkrt MD PhD

PhD Students
S.E. Damhuis
Y. Dawood
C.E. van Dijk
J. Horenblas
C.H.J.R. Jansen
K. van de Kamp
B. Koullali
M.A. Lugthart
A.A. de Ruigh
N.E. Simons MSc
T.M.S. van Winden
M.D. van Zijl

Prof. dr. B.W.J. Mol (Clinical epidemiology in obstetrics, gynaecology and fertility)

Prof. dr. J.A.M. van der Post MD PhD (Reproductive Health, placental disease and maternal and fetal diseases)

Other research related activities
  • Board of directors / Trustees / Supervisory board, SPSAO
  • Board of directors / Trustees / Supervisory board, Stichting Stop te vroeg bevallen
  • Contribution to guidelines and protocols, Datering van de Zwangerschap
  • Contribution to guidelines and protocols, Structureel Echoscopisch onderzoek
  • Contribution to guidelines and protocols, Counseling na prenataal vastgestelde schisis
  • Contribution to guidelines and protocols, Counseling bij genoombrede detectie van chromosoomveranderingen (CNV) middels array of NGS diagnostiek
  • Contribution to training of professionals, NVOG
  • Membership of medical or scientific committee, Ministry of Health, Welfare and Sport, Review commission late pregnancy termination and termination of life of new borns
Current research funding
  • AMC
  • AMC (Vrijgesteld)
  • Stichting Achmea Gezondheidszorg
  • ZonMw