Wieteke M. Heidema

Vaginal prolapse repair surgery augmented by ultra lightweight titanium coated polypropylene mesh

OBJECTIVES To determine the safety and efficacy of ultra lightweight titanium coated polypropylene mesh to augment conventional vaginal prolapse repair in women with recurrent symptomatic prolapse stage II or more or primary prolapse stage III or more. STUDY DESIGN A prospective observational cohort study was performed at two urogynecological centres in The Netherlands. Women with recurrent symptomatic prolapse at least stage II or primary vaginal prolapse ICS POP stage III or more participated in the study. POP-Q and validated urogynecological questionnaires were used pre- and post-operatively. Outcome measures were mesh-related morbidity and prolapse recurrence, defined as ICS POP stage II, as well as changes in domain scores on urogenital distress- and defaecatory distress inventory (UDI and DDI), incontinence impact questionnaire (IIQ) as well as sexual functioning. Wilcoxons signed ranks test for paired variables and 95% confidence intervals, respectively were used to analyse these data. RESULTS The study group comprised 71 patients with a median follow-up of 9 months (6-14). Mesh erosions were detected in four patients (5.6%), all on the posterior vaginal wall. After Ti-mesh((R)) augmentation in 14 patients (36%) the anterior vaginal wall and in 7 patients (18%) the posterior vaginal wall, was categorised as ICS POP stage II and were thus considered failures. UDI and DDI domain scores all improved significantly, except for the domains of incontinence and pain, respectively. Three out of five domains of the IIQ showed significant improvement. Surgery did not have any significant negative impact on sexual functioning. CONCLUSION Ultra lightweight titanized polypropylene mesh to augment conventional vaginal prolapse repair surgery showed minimal morbidity, but no additional value compared to conventional surgery at short-term follow-up.

Cardiovascular disease risk is only elevated in hypertensive, formerly preeclamptic women

To analyse the predicted 10‐ and 30‐year risk scores for cardiovascular disease (CVD) in patients who experienced preeclampsia (PE) 5–10 years previously compared with healthy parous controls.

Pre-eclampsia : an important risk factor for asymptomatic heart failure

Pre‐eclampsia (PE) is associated with both postpartum structural asymptomatic heart disease (i.e. heart failure Stage B (HF‐B)) and conventional cardiovascular (CV) risk factors. We aimed to evaluate the extent to which PE, adjusted for conventional CV risk factors, is associated independently with asymptomatic cardiac abnormalities postpartum.

Metabolic syndrome after pregnancies complicated by pre-eclampsia or small-for-gestational-age: a retrospective cohort

To study the prevalence of metabolic syndrome in women after a pregnancy complicated by pre‐eclampsia or small‐for‐gestational‐age (SGA), both epitomes of placental syndrome.

Prevalence of asymptomatic heart failure in formerly pre-eclamptic women: a cohort study

After pre‐eclampsia (PE), the prevalence of structural heart disease without symptoms, i.e. heart failure Stage B (HF‐B), may be as high as one in four women in the first year postpartum. We hypothesize that a significant number of formerly pre‐eclamptic women with HF‐B postpartum are still in their resolving period and will not have HF‐B during follow‐up.

Decreased endothelial function and increased subclinical heart failure in women several years after pre‐eclampsia

Pre‐eclampsia (PE) is associated with both postpartum endothelial dysfunction and asymptomatic structural heart alterations consistent with heart failure Stage B (HF‐B). In this study, we assessed the relationship between endothelial function, measured by flow‐mediated dilation (FMD), and HF‐B in women with a history of PE.

Recurrent pre-eclampsia in women with metabolic syndrome and low plasma volume: a retrospective cohort study

To determine the prevalence of recurrent pre‐eclampsia in women with a history of pre‐eclampsia with both metabolic syndrome and low plasma volume postpartum, as compared with women without either entity.

History of preeclampsia is more predictive of cardiometabolic and cardiovascular risk factors than obesity

OBJECTIVE To determine to what extent a history of preeclampsia affects traditional cardiometabolic (insulin resistance and dyslipidemia) and cardiovascular (hypertension and micro-albuminuria) risk factors of the metabolic syndrome irrespective of BMI. STUDY DESIGN In a retrospective case-control study we compared 90 formerly preeclamptic women, divided in 3 BMI-classes (BMI 19.5-24.9, 25.0-29.9, ≥30.0kg/m(2)) to 30 controls, matched for BMI, age and parity. Cardiometabolic and cardiovascular risk factors (WHO-criteria) were tested 6-18 months post partum. Statistical analysis included unpaired t-tests, Mann-Whitney U test, or Chi square test and two-way ANOVA. RESULTS Constituents of the metabolic syndrome (glucose, insulin, HOMAIR, HDL-cholesterol, triglycerides, blood pressure, micro-albuminuria) were higher in formerly preeclamptic women than in BMI-matched controls. Resultantly, traditional risk factors were more prevalent in formerly preeclamptic women than in controls (insulin resistance 80% vs 30%, dyslipidemia 52% vs 3%, hypertension 24% vs 0%, micro-albuminuria 30% vs 0%). Cardiometabolic risk factors increased with BMI, to the same extent in both groups. Formerly preeclamptic women had metabolic syndrome more often than their BMI-matched controls (38% vs 3%, p<0.001). CONCLUSION Traditional risk factors of the metabolic syndrome are more prevalent in formerly preeclamptic women than in BMI-matched controls and increase with BMI to the same extent in both groups. A history of preeclampsia seems to be a stronger indicator of cardiovascular risk than obesity per se.

Endothelial and kidney function in women with a history of preeclampsia and healthy parous controls: A case control study

INTRODUCTION Preeclampsia (PE) is a pregnancy related endothelial disease characterized by hypertension and albuminuria. Postpartum endothelial dysfunction often persists in these women. We postulate that in women with a history of PE reduced endothelial dependent vasodilation coincides with attenuated kidney function, as both reflect endothelial dysfunction. METHODS We assessed endothelial and kidney function in women with a history of PE (n=79) and uncomplicated pregnancies (n=49) at least 4years postpartum. Women with hypertension, diabetes or kidney disease prior to pregnancy were excluded. Brachial artery flow mediated dilatation (FMD) was measured and analysed by a custom designed edge-detection and wall-tracking software. We measured albumin and creatinine levels in a 24-h urine sample and calculated glomerular filtration rate (GFR) by CKD-EPI. RESULTS Women with a history of PE had lower FMD but comparable GFR and albumin creatinine ratio (ACR) compared with controls. Independent of obstetric history, in both controls and women with a history of PE respectively, GFR (r=0.19, p=0.17 and r=0.12, p=0.29) and albumin creatinine ratio (r=0.07, p=0.62 and r=0.06 p=0.57) did not correlate with FMD. CONCLUSION At least 4years after pregnancy, women with a history of PE demonstrated decreased flow mediated dilatation when compared to healthy parous controls. In this study, decreased flow mediated dilation however did not coincide with decreased kidney function.

Early enteral tube feeding in optimizing treatment of hyperemesis gravidarum : the Maternal and Offspring outcomes after Treatment of HyperEmesis by Refeeding (MOTHER) randomized controlled trial

Background: Hyperemesis gravidarum (HG) leads to dehydration, poor nutritional intake, and weight loss. HG has been associated with adverse pregnancy outcomes such as low birth weight. Information about the potential effectiveness of treatments for HG is limited.Objective: We hypothesized that in women with HG, early enteral tube feeding in addition to standard care improves birth weight.Design: We performed a multicenter, open-label randomized controlled trial [Maternal and Offspring outcomes after Treatment of HyperEmesis by Refeeding (MOTHER)] in 19 hospitals in the Netherlands. A total of 116 women hospitalized for HG between 5 and 20 wk of gestation were randomly allocated to enteral tube feeding for ≥7 d in addition to standard care with intravenous rehydration and antiemetic treatment or to standard care alone. Women were encouraged to continue tube feeding at home. On the basis of our power calculation, a sample size of 120 women was anticipated. Analyses were performed according to the intention-to-treat principle.Results: Between October 2014 and March 2016 we randomly allocated 59 women to enteral tube feeding and 57 women to standard care. The mean ± SD birth weight was 3160 ± 770 g in the enteral tube feeding group compared with 3200 ± 680 g in the standard care group (mean difference: -40 g, 95% CI: -230, 310 g). Secondary outcomes, including maternal weight gain, duration of hospital stay, readmission rate, nausea and vomiting symptoms, decrease in quality of life, psychological distress, prematurity, and small-for-gestational-age, also were comparable. Of the women allocated to enteral tube feeding, 28 (47%) were treated according to protocol. Enteral tube feeding was discontinued within 7 d of placement in the remaining women, primarily because of its adverse effects (34%).Conclusions: In women with HG, early enteral tube feeding does not improve birth weight or secondary outcomes. Many women discontinued tube feeding because of discomfort, suggesting that it is poorly tolerated as an early routine treatment of HG. This trial was registered at www.trialregister.nl as NTR4197.