Pelvic floor muscle group therapy for the treatment of urinary incontinence during pregnancy and post-partum:A randomized controlled trial

Objective: Pelvic Floor Muscle Group Therapy (PFMGT) is an effective treatment option in the general population. However, the effect of therapy during pregnancy and shortly thereafter is unclear. Therefore, this study investigates the effect of PFMGT in peri-partum women with UI compared to care-as-usual. Materials and Methods: Two randomized controlled trials: Study 1: Pregnant women and study 2: 6 weeks post-partum women, were performed. The primary outcome was UI severity based on the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short form (ICIQ-UI SF). Secondary outcomes were the Global Impression of Severity (GPE) measuring patient’s self-reported improvement and the Incontinence Impact Questionnaire-7 (IIQ-7), measuring UI impact. Descriptive and univariate analysis were reported and the non-parametric Mann-Whitney U test was used to compare differences between groups. Results: Inclusion numbers could not be met, and therefore all women received individual Pelvic floor muscles training (PFMT). Study 1 showed no significant results regarding the prevalence of UI (ICIQ-UI SF), GPE and IIQ-7 at any measurement moment. As compared to baseline, study 2 showed a significant improvement for prevalence of UI and impact of UI at 4 months post-partum, however there was no significant difference between groups at other measurement moments. Significant subjective improvement was seen at 4th and 9th months post-partum, in favor of the PFMT group (p=0.02). Conclusion: PFMT, started after childbirth, demonstrated improved UI and quality of life with a lower number of complaints at the 4 months post-partum assessment. However, the full potential of effectiveness of PFMT could not be established due to insufficient inclusions

DEcreased Cognitive functiON, NEurovascular CorrelaTes and myocardial changes in women with a history of pre-eclampsia (DECONNECT):research protocol for a cross-sectional pilot study

Introduction Pre-eclampsia is a hypertensive disorder affecting up to 8% of pregnancies. After pre-eclampsia, women are at increased risk of cognitive problems, and cerebrovascular and cardiovascular disorders. These sequelae could result from microvascular dysfunction persisting after pre-eclampsia. This study will explore differences in cerebral and myocardial microvascular function between women after pre-eclampsia and women after normotensive gestation. We hypothesise that pre-eclampsia alters cerebral and myocardial microvascular functions, which in turn are related to diminished cognitive and cardiac performance. Methods and analysis The cross-sectional € DEcreased Cognitive functiON, NEurovascular CorrelaTes and myocardial changes in women with a history of pre-eclampsia' (DECONNECT) pilot study includes women after pre-eclampsia and controls after normotensive pregnancy between 6 months and 20 years after gestation. We recruit women from the Queen of Hearts study, a study investigating subclinical heart failure after pre-eclampsia. Neuropsychological tests are employed to assess different cognitive domains, including attention, processing speed, and cognitive control. Cerebral images are recorded using a 7 Tesla MRI to assess blood-brain barrier integrity, perfusion, blood flow, functional and structural networks, and anatomical dimensions. Cardiac images are recorded using a 3 Tesla MRI to assess cardiac perfusion, strain, dimensions, mass, and degree of fibrosis. We assess the effect of a history of pre-eclampsia using multivariable regression analyses. Ethics and dissemination This study is approved by the Ethics Committee of Maastricht University Medical Centre (METC azM/UM, NL47252.068.14). Knowledge dissemination will include scientific publications, presentations at conferences and public forums, and social media. Trial registration number NCT02347540.</p

Maternal Cardiovascular Physiology and Assessment

Maternal cardiovascular function changes dramatically in pregnancy with a first-trimester increase in heart rate, followed by a gradual reduction in vascular resistance and blood pressure, and compensatory increase in both intravascular fluid and cardiac output. Many techniques are now available for measuring cardiac output, vascular resistance, and arterial function including those based on bio-impedance, ultrasound, applanation tonometry, inert gas rebreathing, and Doppler, though there is no ‘gold standard’. The techniques are not interchangeable cross-sectionally, but can be used for serial assessments longitudinally in pregnancy. A knowledge of maternal cardiovascular physiology is essential in making sense of the changes that occur in pathological conditions of pregnancy

Plasma Volume Changes in Pregnancy

Under healthy conditions, only one-third of the plasma volume is located in the arterial compartment, whereas the remainder is located in the venous compartment to balance increased arterial demands. In normotensive formerly preeclamptic women, about half have low plasma volume, a condition paralleled by reduced venous compliance, blunted responsiveness to orthostatic stress and consistently higher sympathetic tone. Low plasma volume therefore seems to represent reduced venous reserve capacity. Functionally, prepregnancy low plasma volume predisposes to early-pregnancy circulatory maladaptation; clinically, it relates to increased risk on recurrent hypertensive disease, growth restriction and preterm birth. Modulation of the plasma volume compartment may therefore reduce the risk of recurrent gestational hypertensive sequellae in women with prepregnancy reduced plasma volume

Low plasma volume coincides with sympathetic hyperactivity and reduced baroreflex sensitivity in formerly preeclamptic patients.

Contains fulltext : 50660.pdf (publisher's version ) (Open Access)BACKGROUND: Preeclampsia is associated with enhanced sympathetic activity as well as subnormal plasma volume. Meanwhile, in over 50% of these complicated pregnancies, the subnormal plasma volume has been found to persist for a prolonged period after pregnancy. The objective of this study is to test the hypothesis that in normotensive formerly-preeclamptic women, persistence of a subnormal plasma volume coincides with enhanced sympathetic activity and with it, an altered autonomic control of blood pressure. METHODS: Forty-eight formerly-preeclamptic women participated in this study. After measurement of their plasma volume by iodine 125-albumin indicator dilution, they were subdivided into a group with a normal plasma volume (plasma volume > 48 ml/kg lean body mass) and a group with a subnormal plasma volume (< or = 48 ml/kg lean body mass). We performed spectral analysis on their beat-to-beat blood pressure and heart rate recordings and compared both groups using non-parametric tests. RESULTS: Formerly-preeclamptic women with a subnormal plasma volume had a higher sympathetic activity (P = .001) and a lower baroreflex sensitivity (P = .04) than their counterparts with a normal plasma volume. CONCLUSION: In normotensive formerly-preeclamptic women, a subnormal plasma volume coincides with a higher sympathetic activity in the blood pressure regulation and lower baroreflex sensitivity. Whether these alterations in the autonomic control mechanisms are a cause or effect of the subnormal plasma volume remains to be elucidated

Factors influencing influencing postpartum women's willingness to participate in a preventive pelvic floor muscle training program: a web-based survey

OBJECTIVE\nPregnancy and delivery are the most prominent risk factors for the onset of pelvic floor injuries and – later-on – urinary incontinence. Supervised pelvic floor muscle training during and after pregnancy is proven effective for the prevention of urinary incontinence on the short term. However, only a minority of women do participate in preventive pelvic floor muscle training programs. Our aim was to analyze willingness to participate (WTP) in an intensive preventive pelvic floor muscle training (PFMT) program and influencing factors, from the perspective of postpartum women, for participation. \n\nSTUDY DESIGN\nWe included 169 three-month postpartum women in a web-based survey in the Netherlands. Demographic and clinical characteristics, knowledge and experience with PFMT and preconditions for actual WTP were assessed. Main outcome measures were frequencies and percentages for categorical data. Cross tabulations were used to explore the relationship between WTP and various independent categorical variables. A linear regression analysis was done to analyze which variables are associated with WTP. \n\nRESULTS\nA response rate of 64% (n=169) was achieved. 31% of the women was WTP, 41% was hesitating, 12% already participated in PFMT and 15% was not interested (at all). No statistically significant association was found between WTP and risk or prognostic pelvic floor dysfunction factors. Women already having symptoms of pelvic floor dysfunction such as incontinence and pelvic organ prolapse symptoms were more WTP (p=0.010, p=0.001, respectively) as were women perceiving better general health (

Prediction Model Based on Easily Available Markers for Aberrant Cardiac Remodeling in Women After Pregnancy

BACKGROUND: Preeclampsia is strongly associated with left ventricular concentric remodeling (LVCR) and left ventricular hypertrophy (LVH) up to 10 years after delivery. This predisposes to heart failure later in life. Adequate detection and prediction of LVCR or LVH is expected to decrease the risk of developing clinical heart failure within this high-risk female population. Therefore, we developed and internally validated a prediction model for aberrant cardiac remodeling in formerly pregnant women. METHODS: This large cohort study included women with a history of preeclampsia or normotensive pregnancy within a postpartum interval of 6 months to 30 years. Cardiovascular assessment was performed, including echocardiography, 30-minute blood pressure measurements, and circulating biomarkers. Aberrant cardiac remodeling based on echocardiographic findings was defined as either LVCR or LVH. Discriminative performance was evaluated by the area under the receiver operating characteristic curve. RESULTS: A total of 1397 women were included, of which 139 (10%) with LVCR or LVH (mean±SD age, 43±9 years) and 1258 (90%) without LVCR or LVH (40±8 years). The final prediction model was established based on the predictors age, waist circumference, systolic blood pressure, glycated hemoglobin, antihypertensive medication use, and early onset preeclampsia (yes/no). After internal validation, the prediction model showed accurate discriminative ability with an area under the receiver operating characteristic curve of 0.702 (95% CI, 0.657-0.756). CONCLUSIONS: Based on the conventional predictors, we developed a prediction model for women who are on average 8 to 12 years postpartum. Internal validation showed accurate discriminative ability. Upon external validation, this model may aid clinicians to initiate further diagnostic testing or clinical follow-up. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT02347540

Simple prepregnant prediction rule for recurrent early-onset hypertensive disease in pregnancy.

Contains fulltext : 81541.pdf (publisher's version ) (Closed access)OBJECTIVE: We aimed to develop a simple clinically useful prediction rule for early-onset recurrent preeclampsia and/or HELLP syndrome. METHODS: Women with previous early-onset preeclampsia and/or HELLP, enrolled between 1996 and 2007, and a subsequent ongoing pregnancy were included. Prepregnant cardiovascular, metabolic, renal, and clotting parameters were evaluated as potential predictors for recurrent disease by logistic regression analysis. RESULTS: Early-onset preeclampsia and/or HELLP recurred in 16 (9%) of 186 next pregnancies. The prediction model included high-density lipoprotein (mmol/L) and 24-hour urinary total protein excretion (mg/mmol creatinine). The receiver operating characteristic area was 0.77 (95% confidence interval: 0.68-0.87). Predictive sensitivity and specificity were 94% (69%-99%) and 53% (45%-60%), respectively. Nearly 50% of the women could be classified as having <1% risk of recurrent early-onset disease. CONCLUSIONS: The prediction rule identified, with clinically relevant predictive capacity, those women at very low risk for recurrent early-onset disease