Hendrik Cammu

A 10-year follow-up after Kegel pelvic floor muscle exercises for genuine stress incontinence.

Objective To determine the outcome 10 years after an individual course of pelvic floor muscle (PFM) exercises for genuine stress incontinence.

‘To bathe or not to bathe’ during the first stage of labor

Objective. Does a warm tub bath relieve labor pain? How is it experienced by the parturient?

Pelvic floor exercises versus vaginal weight cones in genuine stress incontinence.

OBJECTIVE To compare pelvic floor exercises and vaginal weight cones in the treatment of genuine stress incontinence. STUDY DESIGN Randomised controlled trial. METHODS Sixty ambulatory and fit white women (mean age 56 years) with urinary stress incontinence, treated by a single physiotherapist as outpatients during twelve weeks. Thirty women were allocated to a weekly session of pelvic floor exercises. Thirty were allocated to using cones, they were seen every two weeks. OUTCOME MEASURES Objective: stress test, vaginal squeezing capacity. Subjective: urinary diary, visual analogue scales. RESULTS Characteristics of both study groups were comparable. Unfortunately, there was an early withdrawal of fourteen (47%) women in the group treated with cones, and none in the other group. Therefore the pelvic floor exercise group was compared not only with the group intended to be treated with cones, but also with the selected group that only received cone therapy. No statistically significantly differences in outcome measures were found between the groups: 53% in the group assigned to pelvic floor exercises and 57% into the group assigned to cones, of which 50% in the group actually treated with cones, considered themselves as cured or improved to a significant degree. Long-term follow-up was not possible as all cone users refused continued exercises with cones once the twelve weeks had ended. CONCLUSION Pelvic floor exercises and cones are equally effective in the treatment of genuine stress incontinence. Cones are cost and time saving. However, the low patient compliance with the cones importantly limits its clinical applicability, especially in the long run. Therefore, we do not recommend the use of cones.

Epidemiology and Pathogenesis of Ureaplasma Urealyticum in Spontaneous Abortion and Early Preterm Labor

The role of U. urealyticum in spontaneous and recurrent spontaneous abortion was studied in 633 women. Cervical colonization with U. urealyticum was found in 42.6% of 310 normal pregnant women, in 41.6% of 84 patients who underwent induced abortion, in 41.5% of 41 normal fertile patients, in 53.3% of 122 patients with spontaneous abortion and in 64.5% of 76 patients with recurrent spontaneous abortion. The cervical isolation rate was significantly higher in patients with spontaneous abortion (p<0.05) and recurrent spontaneous abortion (p<0.005) than in normal pregnant women. Endometrial colonization was more frequent in patients with recurrent spontaneous abortion (27.6%) than in normal fertile women (9.7%) (p<0.05). Moreover, in 6 patients with intact membranes and uncontrollable preterm labor resulting in fetal loss (all between the 20th and 28th week of gestation) U. urealyticum was isolated in 5 of them from the cervix, in 4 patients from the placenta and in 2 out of 4 from the amniotic fluid. Histological examination of the placenta showed signs of chorioamnionitis in 5 patients. From this study we conclude that although U. urealyticum is a common inhabitant of the lower genital tract, it may play a role in the etiology of spontaneous abortion and uncontrollable preterm labor.

C‐reactive protein in preterm labour; association with outcome of tocolysis and placental histology

Tocolytics were administered in 66 consecutive women in uncomplicated preterm labour with intact fetal membranes (53 singleton and 13 twin pregnancies). C‐reactive protein (CRP), a marker of infection, was determined daily and used retrospectively to investigate the role of subclinical infection in preterm labour and to predict the efficacy of tocolysis and the development of a clinical perinatal infection. CRP was also determined in 66 women in uncomplicated labour at term (53 singleton and 13 twin pregnancies). The placenta was examined for histological evidence of infection in all patients who were delivered bcfore 36 weeks (n=21) and in all women in the control group (n=66). Elevated CRP levels were more often found in patients who were refractory to tocolysis, suggesting an underlying infectious morbidity. Placental infection was found in 62% of the preterm delivery group and in 12% of the control group. There was an association between elevated CRP levels and histological evidence of placental infection. However, confounding factors such as urinary tract infections limit the usefulness of the CRP test. Because CRP cannot predict clinical perinatal infection accurately, its clinical relevance is very limited.

Dramatic increase (1997–2007) in the number of procedures for stress urinary incontinence in Belgium

Introduction and hypothesisWe wondered if the tension-free vaginal tape approach, introduced in 1998, influenced the rate of anti-incontinence surgery.MethodsWe determined the rates of anti-incontinence surgery in Belgium between 1997 and 2007, using the Belgian National Health Insurance Fund register covering the entire adult female population of nearly 4,420,000 women in Belgiun.ResultsThe rate per 1,000 women of anti-incontinence surgery increased from 0.54 in 1997 to 2.03 in 2004, after which a plateau was reached (2.01 in 2007). This nearly fourfold increase coincided with the introduction in 1998 on the Belgian market of the tension-free vaginal tape (+66% more interventions between 1998 and 2001). After the introduction of the transobturator tape in 2001, the rate increased even more dramatically (+118% between 2001 and 2004).ConclusionsRates of anti-incontinence surgery increased by 272% in Belgium between 1997 and 2007. This increase coincided with the availability of tension-free mesh sling operations.

Fetal and infant health outcomes among immigrant mothers in Flanders, Belgium

To compare fetal and infant mortality between immigrant and native‐born mothers in Flanders, Belgium.

Pelvic floor muscle exercises in genuine urinary stress incontinence.

Pelvic floor muscle exercises, in the treatment of genuine stress incontinence, have been used successfully since 1948. One may expect a significant improvement (warranting no further therapy), or cure rate of about 50%. These exercises have a long-lasting effect. Poorly motivated women should be discouraged to follow exercise sessions. An active co-operation between urogynecologist, physiotherapist and the patient is important in order to avoid undertreated and dissatisfied women. The option to be operated upon must be easily available.

Abnormally adherent placentation: a life-threatening complication

Two cases are presented illustrating the potential danger of abnormal placentation. Placenta accreta is frequently associated with placenta praevia and/or a history of previous caesarean section. As there are no obvious specific symptoms before or during delivery, one should consider the possibility of this anomaly in the third stage of labour when manual removal of the placenta is very arduous. The treatment of choice is immediate abdominal hysterectomy, for this is followed by the lowest maternal mortality. If abnormal placentation is suspected, one should be prepared to deal with it as necessitated, including the possible performance of an emergency caesarean hysterectomy.

Perceptions of fatigue – and perceived consequences – among Flemish obstetricians-gynaecologists: A survey

Abstract Objectives The effects of fatigue on the performance of medical trainees have been extensively studied. Much less is known about the effects of fatigue among doctors who have completed their training. The aim of this study was to inquire about the perception of fatigue and its consequences among certified obstetricians-gynaecologists (OGs). Methods A questionnaire was mailed to all certified OGs working in Flanders (Northern Belgium). Descriptive statistics as well as uni- and multivariate analyses for potential determinants of fatigue are presented. Results Of the 450 questionnaires mailed, 260 (58%) were returned. Half (52%) of the doctors worked more than 60 h/week. During an average working day, four out of ten respondents indicated they experienced a certain degree of fatigue, and one in ten felt really tired. Fatigue was associated with long working hours and led in a sizeable proportion of respondents to dissatisfaction (29%) and to medical/surgical errors (19%). None of the perceived errors resulted in loss of life. Academic OGs worked more hours/week but fewer during the night than their colleagues in private practice. The former reported having made significantly more medical errors (26%) than the latter (11%). Conclusions Tired OGs have less job satisfaction, and perceive they make more errors. None of the perceived errors resulted in loss of life. Certified OGs working more than 60 h/week are more frequently tired.