Patient Impression of Improvement 1 year After Sacrospinous Hysteropexy Versus Vaginal Hysterectomy in Women with Pelvic Organ Prolapse Stage 2 or Higher.

INTRODUCTION AND HYPOTHESIS: Patient-reported outcomes are relevant outcomes in studies on pelvic organ prolapse (POP) surgery, as anatomical recurrence alone does not have a significant correlation with perceived improvement. In the present study, the patient's impression of improvement after 1 year is studied after vaginal hysterectomy (VH) versus sacrospinous hysteropexy (SSH) in large cohorts from daily clinical practice. We hypothesize that there is no difference between the groups. METHODS: This is a secondary analysis on prospectively collected data in a multicenter cohort of patients who underwent VH or SSH for symptomatic POP. All patients had a POP-Q stage ≥ 2 in at least one compartment at baseline and were treated with VH or SSH between 2002 and 2019. The primary outcome was the patient-reported score on the patient global impression of improvement index (PGI-I) 1 year after surgery. The secondary outcome was a composite outcome of surgical success, defined as the absence of recurrent POP beyond the hymen with bothersome bulge symptoms and/or repeat surgery. RESULTS: A total of 378 women (196 VH and 182 SSH) were included. The median score on the PGI-I did not differ between VH and SSH. At 1 year post-operatively, 77 women after VH (73%) and 77 women after SSH (75%) considered their condition (very) much improved (p = 0.86). There was no difference in composite outcome of surgical success (126 out of 137 women [92%] after VH, 118 out of 125 women [94%] after SSH; p = 0.44). CONCLUSIONS: Our study shows that there was no difference in the type of surgery, VH or SSH, with regard to the patient's impression of improvement 1 year postoperatively in a large cohort from daily clinical practice.

Maternal characteristics of a cohort of preterm infants with a birth weight ≤750 g without major structural anomalies and chromosomal abnormalities.

Our objectives were to describe the obstetric complications of women who delivered an extremely low-birth-weight infant by comparing two consecutive 5-year periods and infants appropriate for gestational age (AGA) versus infants small for gestational age (SGA). This descriptive study included women ( N = 261) who delivered an infant ≤750 g (major structural and chromosomal anomalies excluded) between 1996 and 2000 (cohort I, N = 145) and 2001 to 2005 (cohort II, N = 116) in the University Hospital Utrecht, the Netherlands. Of these, 84.3% of the multigravidas ( N = 121) had a complicated obstetric history: 46.3% miscarriage(s), 22.3% preterm deliveries, and 16.5% hypertensive disorders. In the index pregnancies ( N = 261), the most prevalent complications were hypertensive disorders (52.1%, P = 0.002; more in cohort II) and SGA ( P = 0.007), fetal distress (39.5%), and intrauterine growth restriction (32.6%) resulting in a caesarean section in 47.9% and a spontaneous vaginal delivery in 19.2%. Intrauterine deaths occurred in 35.2%, merely due to placental insufficiency (59.8%) and termination of pregnancy because of deteriorating hypertensive disorders (23.9%). A high percentage of parous mothers had a seriously complicated obstetric history. The index pregnancy was largely complicated by hypertensive disorders. The majority of infants with a birth weight ≤750 g were growth-restricted due to placental insufficiency. Follow-up is extremely important to evaluate neonatal morbidity and neurodevelopmental outcome.