Willem Ankum | University of Amsterdam (original) (raw)
Papers by Willem Ankum
BMC Pregnancy and Childbirth, 2013
Background: Medical treatment with misoprostol is a non-invasive and inexpensive treatment option... more Background: Medical treatment with misoprostol is a non-invasive and inexpensive treatment option in first trimester miscarriage. However, about 30% of women treated with misoprostol have incomplete evacuation of the uterus. Despite being relatively asymptomatic in most cases, this finding often leads to additional surgical treatment (curettage). A comparison of effectiveness and cost-effectiveness of surgical management versus expectant management is lacking in women with incomplete miscarriage after misoprostol.
BMC Women's Health, 2008
Background: Patients with ectopic pregnancy (EP) and low serum hCG concentrations and women with ... more Background: Patients with ectopic pregnancy (EP) and low serum hCG concentrations and women with a pregnancy of unknown location (PUL) and plateauing serum hCG levels are commonly treated with systemic methotrexate (MTX). However, there is no evidence that treatment in these particular subgroups of women is necessary as many of these early EPs may resolve spontaneously. The aim of this study is whether expectant management in women with EP or PUL and with low but plateauing serum hCG concentrations is an alternative to MTX treatment in terms of treatment success, future pregnancy, health related quality of life and costs.
Nederlands tijdschrift voor geneeskunde
To review the current policy in diagnosis and treatment of recurrent miscarriage in the Netherlan... more To review the current policy in diagnosis and treatment of recurrent miscarriage in the Netherlands. Cross-sectional survey. A printed questionnaire was sent in 1996 to all 125 departments of gynaecology in the Netherlands with questions about definition, investigation and therapy of recurrent miscarriage. The response rate was 90% (n = 112). Twenty-nine per cent of the respondents defined recurrent miscarriage as having two or more abortions and 71% as three or more abortions. In 42% of the departments a diagnostic protocol for recurrent miscarriage was present. Diagnostic investigations most frequently performed were vaginal ultrasound (79%), parental chromosome analysis (78%), thyroid-stimulating hormone (72%), lupus anticoagulant (69%), blood glucose (65%), hysterosalpingography (56%) and anticardiolipin antibodies (IgG, IgM) (56%). Therapy most frequently applied was prescription of folic acid (53%). The definition of recurrent miscarriage differed. Uncertainty about a rational diagnostic approach was evident from the large number of tests requested by 20-50% of the respondents. Some diagnostic tests like immunological investigation and search for infectious factors were not followed by a therapeutical intervention.
Journal of The American Society of Nephrology, 2004
Gastroenterology, 2002
Ultrasonography, the gold standard for establishing a diagnosis in first-trimester vaginal bleedi... more Ultrasonography, the gold standard for establishing a diagnosis in first-trimester vaginal bleeding, is not always readily avaliable. Medical history and gynaecological examination are then used instead, to make a provisional diagnosis. To determine the diagnostic value of history taking and physical examination in first-trimester bleeding, to differentiate between patients requiring immediate further diagnostic examination from those in whom an expectant policy will initially suffice. Prospective population-based cohort study. Seventy-four general practices in Amsterdam. Two hundred and twenty-five patients with first trimester vaginal bleeding were referred for an early pregnancy assessment. The data from 204 patients were analysed. Two diagnostic models were constructed based on symptoms and the results of gynaecological examination to identify diagnostic subgroups relevant to clinical practice. Model 1, which separates viable pregnancies from other diagnoses, increased pre-test probability from 47% to a post-test probability of 70%. Model 2, which enabled the identification of complete miscarriages, resulted in a post-test probability of 41% of a complete miscarriage, given a pre-test sample probability of 25%. The tentative diagnosis of a general practitioner, based entirely on clinical judgement, turned out to be a poor predictor for the ultrasonographically confirmed diagnosis (pre-test probability of 47% changed to a post-test probability of 58%). This study shows that, in first trimester bleeding, neither statistical prediction models based on signs and symptoms, nor clinical judgement, are valid replacements for ultrasonographic assessment in establishing a diagnosis.
Carcinogenesis, 2003
Background: Expectant management is an alternative for curettage in women with a miscarriage. Aim... more Background: Expectant management is an alternative for curettage in women with a miscarriage. Aim: To assess the pattern of vaginal bleeding and pain in expectantly managed women with a miscarriage, and to analyse the factors predictive of a relatively quick spontaneous loss of pregnancy. Design of study: Part of a study comparing expectant management with surgical evacuation. Setting: Two hospitals in Amsterdam.
Obstetrical and Gynecological Survey
Ectopic pregnancy occurs in about 1% of pregnant women. This early pregnancy complication may be ... more Ectopic pregnancy occurs in about 1% of pregnant women. This early pregnancy complication may be life-threatening and adversely affect future fertility. The ability to diagnose this condition before it has deteriorated has changed it from a life-threatening disease into a more benign manageable one. This article reviews changes during the past century in the diagnostic and therapeutic management of ectopic pregnancies. At the beginning of the 20th century, the first diagnostic tool was surgery, initially laparotomy. With the adoption of laparoscopy as a mainstream gynecology procedure decades later, the diagnosis became timelier and less morbid. In the 1970s, a nonsurgical diagnostic strategy was developed to manage ectopic pregnancies using a combination of high-resolution ultrasonography and sensitive serum human chorionic gonadotropin (hCG) assays. Advances in diagnostic ultrasonography have resulted in expansion of the diagnosis ectopic pregnancy into multiple categories related...
European journal of obstetrics, gynecology, and reproductive biology, Jan 17, 2015
To study the impact on health-related quality of life (HRQoL) of treatment with systemic methotre... more To study the impact on health-related quality of life (HRQoL) of treatment with systemic methotrexate (MTX) or expectant management in women with ectopic pregnancy or pregnancy of unknown location (PUL) with low and plateauing serum hCG concentrations. HRQoL was assessed alongside a randomized clinical trial (RCT) with the use of standard self-administered psychometric measure questionnaires. All women who participated in the multicenter RCT comparing treatment with systemic MTX to expectant management in women with ectopic pregnancy or persisting PUL were eligible for the HRQoL measurements. HRQoL measures of three standardized questionnaires (SF-36, RSCL, HADS). Data were available for 64 of 73 women (78%) randomized in the RCT. We found no difference in HRQoL between the two treatment groups. The need for additional treatment, i.e. additional MTX injections or surgical intervention, had no impact on HRQoL. Women treated with MTX or expectant management for an ectopic pregnancy or...
American journal of hypertension, Jan 4, 2015
Creatine kinase (CK) is a main predictor of blood pressure, and this is thought to largely depend... more Creatine kinase (CK) is a main predictor of blood pressure, and this is thought to largely depend on high resistance artery contractility. We previously reported an association between vascular contractility and CK in normotensive pregnancy, but pregnancy is a strong CK inducer, and data on human hypertension are lacking. Therefore, we further explored CK-dependency of vascular contractility outside the context of pregnancy in normotensive and hypertensive women. Nineteen consecutive women, mean age 42 years (SE 1.3), mean systolic/diastolic blood pressure respectively 142.6 (SE 5.9)/85.6 (3.4) mm Hg (9 hypertensive), donated an omental fat sample during abdominal surgery. We compared vasodilation after the specific CK inhibitor 2,4-dinitro-1-fluorobenzene (DNFB; 10(-6) mol/l) to sodium nitroprusside (10(-6) mol/l) in isolated resistance arteries using a wire myograph. Additionally, we assessed predictors of vasoconstrictive force. DNFB reduced vascular contractility to 24.3% (SE 4....
Obstetrics and Gynecology International, 2014
Objectives. To survey practice variation in the management of first trimester miscarriage in The ... more Objectives. To survey practice variation in the management of first trimester miscarriage in The Netherlands. Methods. We sent an online questionnaire to gynecologists in eight academic, 37 nonacademic teaching, and 47 nonteaching hospitals. Main outcome measures were availability of a local protocol; estimated number of patients treated with curettage, misoprostol, or expectant management; misoprostol regimen; and estimated number of curettages performed after initial misoprostol treatment. Outcomes were compared to the results of a previous nationwide survey. Results. The response rate was 100%. A miscarriage protocol was present in all academic hospitals, 68% of nonacademic teaching hospitals, and 38% of nonteaching hospitals ( = 0.008). Misoprostol was first-choice treatment for 41% of patients in academic hospitals versus 34% and 27% in teaching-and nonteaching hospitals ( = 0.045). There were 23 different misoprostol regimens. Curettage was first-choice treatment in 29% of patients in academic hospitals versus 46% and 50% in nonacademic teaching or nonteaching hospitals ( = 0.007). In 30% of patients, initial misoprostol treatment was followed by curettage. Conclusions. Although the percentage of gynaecologists who are aware of the availability of misoprostol for miscarriage treatment has doubled to almost 100% since 2005, practice variation is still large. This practice variation underlines the need for a national guideline.
Reproductive BioMedicine Online, 2015
In this observational study, the effect of the introduction of the first Early Pregnancy Assessme... more In this observational study, the effect of the introduction of the first Early Pregnancy Assessment Unit (EPAU) in a university hospital in The Netherlands in 2008 on early pregnancy care is analysed. Derivatives of quality of care were measured before and after the establishment of the EPAU, with the aim of reducing unnecessary care. Care within three time periods was measured: 2006, 2009 and 2012. In 2006, 14% of women who had experienced a miscarriage were admitted to the hospital, whereas in 2009 and 2012 no women were admitted. The surgical management rate for miscarriage decreased from 79% (2006) to 6% (2009) and 28% (2012). Karyotyping of couples who had experienced recurrent miscarriage decreased from 100% (2006) to 17% (2009) and 33% (2012). The surgical management rate for ectopic pregnancy decreased from 50% (2006) to 25% (2009) and 29% (2012). The mean total cost per woman treated in 2006 was €1111 (95% CI €808 to 1426), €436 (95% CI €307 to 590) in 2009 and €633 (95% CI €586 to 788) in 2012. We can therefore conclude that an EPAU results in higher quality and cost-effective care, and has a positive effect on early pregnancy care.
Journal of Laparoendoscopic & Advanced Surgical Techniques
The balloon dilator is used in a variety of minimally invasive preperitoneal and retroperitoneal ... more The balloon dilator is used in a variety of minimally invasive preperitoneal and retroperitoneal operations. In this study, we compared the ability to create an extraperitoneal cavity using a balloon spacer in patients with and without previous abdominal surgery undergoing laparoscopic bladder neck suspension. This prospective study included 38 patients in total, 15 of whom had had previous abdominal wall surgery and 23 who had not. A balloon spacer technique was used to develop the extraperitoneal space. In 80% of the patients with previous surgery, the introduction of the balloon spacer was recorded as simple; in 20%, it was considered difficult. In 78% of the patients without previous surgery, the introduction of the balloon spacer was recorded as simple, in 17% it was difficult, and in 4% it failed. In 80% of the patients with previous surgery, the extraperitoneal view was good or acceptable, in 20% it was poor, and in 13% it failed. In 92% of the patients without previous surge...
Gastroenterology, 2002
BACKGROUND: Expectant management, although less effective, is an alternative treatment option for... more BACKGROUND: Expectant management, although less effective, is an alternative treatment option for surgical evacuation in women with a miscarriage. We assessed health-related quality of life (HRQL) differences over time between expectant and surgical management in women with a miscarriage. METHODS: Women with a miscarriage were randomized to either expectant (n 64) or surgical (n 58) management, and 305 eligible women
![Research paper thumbnail of [Treatment options for early miscarriage; new insights]](https://attachments.academia-assets.com/39995421/thumbnails/1.jpg)
](Nederlands tijdschrift voor geneeskunde, 2014
Miscarriage is the most common complication during the first trimester of pregnancy. Three treatm... more Miscarriage is the most common complication during the first trimester of pregnancy. Three treatment options are available for women who experience early miscarriage: expectant management, curettage, or medical treatment. Curettage has traditionally been the usual treatment, but both expectant management and medical management with misoprostol are more cost-effective. Curettage increases the risk of surgical complications and intra-uterine adhesions (Asherman syndrome), and is associated with preterm birth. After adequate counselling, the woman's preference is a decisive factor; the choice of treatment for early miscarriage lends itself ideally to shared decision making. The Netherlands lacks a multidisciplinary guideline on the treatment of women following miscarriage.
Nederlands tijdschrift voor geneeskunde, 2009
Problems in the first trimester of pregnancy frequently occur. Examples are miscarriage, ectopic ... more Problems in the first trimester of pregnancy frequently occur. Examples are miscarriage, ectopic pregnancy and recurrent miscarriage. In Dutch hospitals there is a growing interest in the setting up of 'early pregnancy units' (EPUs). The aim of these EPUs is to improve the quality of care for women with early pregnancy problems by centralising the care and knowledge available. This centralisation could prevent over- and underdiagnosis and over- and undertreatment. Moreover, EPUs could improve the logistics of clinical research. The potential effectiveness of these units in the Netherlands still needs to be investigated.
European Journal of Obstetrics & Gynecology and Reproductive Biology, 2015
The volume of a fibroid uterus before performing hysterectomy is typically estimated through bima... more The volume of a fibroid uterus before performing hysterectomy is typically estimated through bimanual examination and confirmed by ultrasonography. This study compares estimated volumes by bimanual examination and ultrasound examination with MRI and actual volumes obtained from histopathology, as gold standards. We used data from a previous prospective randomized multi-center trial that compared hysterectomy and uterine artery embolization (UAE) for the treatment of symptomatic fibroids. All patients underwent bimanual vaginal examination and pelvic ultrasonography. Those women randomized to UAE received a pelvic MRI. For women randomized to hysterectomy, the exact uterine volume was based on histopathologic examination. We compared the calculated volumes based on ultrasound parameters and estimated volume based on bimanual examination with either the calculated volumes of the pelvic MRI parameters or the calculated volume based on the exact weight during histological examinations. Our study demonstrated poor agreement between ultrasound and bimanual examination compared with exact volume during histopathologic examination and MRI-based volume. The agreement within the patient group with uterine volume >233 g and >747 g was fair to good. For those women with a uterine volume between 233 and 747 g, the agreement was poor when comparing bimanual estimates with volume obtained from MRI or histolopathologic examination. Within this volume group, the agreement on uterine volume between ultrasound and MRI or histopathologic examination was fair. Our study shows that uterine volume as estimated by ultrasound and bimanual examination can be used for small or large uteri. For uteri with an intermediate volume, bimanual examination and ultrasound are less reliable.
American Journal of Hypertension, 2014
Female-specific risk factors for cardiovascular disease are understudied. We assessed whether wom... more Female-specific risk factors for cardiovascular disease are understudied. We assessed whether women with uterine fibroids have a greater hypertension risk, independent of the shared risk factors for both conditions.
The Lancet, 2014
Background Tubal ectopic pregnancy can be surgically treated by salpingectomy, in which the aff e... more Background Tubal ectopic pregnancy can be surgically treated by salpingectomy, in which the aff ected Fallopian tube is removed, or salpingotomy, in which the tube is preserved. Despite potentially increased risks of persistent trophoblast and repeat ectopic pregnancy, salpingotomy is often preferred over salpingectomy because the preservation of both tubes is assumed to off er favourable fertility prospects, although little evidence exists to support this assumption. We aimed to assess whether salpingotomy would improve rates of ongoing pregnancy by natural conception compared with salpingectomy.
BMC Pregnancy and Childbirth, 2013
Background: Medical treatment with misoprostol is a non-invasive and inexpensive treatment option... more Background: Medical treatment with misoprostol is a non-invasive and inexpensive treatment option in first trimester miscarriage. However, about 30% of women treated with misoprostol have incomplete evacuation of the uterus. Despite being relatively asymptomatic in most cases, this finding often leads to additional surgical treatment (curettage). A comparison of effectiveness and cost-effectiveness of surgical management versus expectant management is lacking in women with incomplete miscarriage after misoprostol.
BMC Women's Health, 2008
Background: Patients with ectopic pregnancy (EP) and low serum hCG concentrations and women with ... more Background: Patients with ectopic pregnancy (EP) and low serum hCG concentrations and women with a pregnancy of unknown location (PUL) and plateauing serum hCG levels are commonly treated with systemic methotrexate (MTX). However, there is no evidence that treatment in these particular subgroups of women is necessary as many of these early EPs may resolve spontaneously. The aim of this study is whether expectant management in women with EP or PUL and with low but plateauing serum hCG concentrations is an alternative to MTX treatment in terms of treatment success, future pregnancy, health related quality of life and costs.
Nederlands tijdschrift voor geneeskunde
To review the current policy in diagnosis and treatment of recurrent miscarriage in the Netherlan... more To review the current policy in diagnosis and treatment of recurrent miscarriage in the Netherlands. Cross-sectional survey. A printed questionnaire was sent in 1996 to all 125 departments of gynaecology in the Netherlands with questions about definition, investigation and therapy of recurrent miscarriage. The response rate was 90% (n = 112). Twenty-nine per cent of the respondents defined recurrent miscarriage as having two or more abortions and 71% as three or more abortions. In 42% of the departments a diagnostic protocol for recurrent miscarriage was present. Diagnostic investigations most frequently performed were vaginal ultrasound (79%), parental chromosome analysis (78%), thyroid-stimulating hormone (72%), lupus anticoagulant (69%), blood glucose (65%), hysterosalpingography (56%) and anticardiolipin antibodies (IgG, IgM) (56%). Therapy most frequently applied was prescription of folic acid (53%). The definition of recurrent miscarriage differed. Uncertainty about a rational diagnostic approach was evident from the large number of tests requested by 20-50% of the respondents. Some diagnostic tests like immunological investigation and search for infectious factors were not followed by a therapeutical intervention.
Journal of The American Society of Nephrology, 2004
Gastroenterology, 2002
Ultrasonography, the gold standard for establishing a diagnosis in first-trimester vaginal bleedi... more Ultrasonography, the gold standard for establishing a diagnosis in first-trimester vaginal bleeding, is not always readily avaliable. Medical history and gynaecological examination are then used instead, to make a provisional diagnosis. To determine the diagnostic value of history taking and physical examination in first-trimester bleeding, to differentiate between patients requiring immediate further diagnostic examination from those in whom an expectant policy will initially suffice. Prospective population-based cohort study. Seventy-four general practices in Amsterdam. Two hundred and twenty-five patients with first trimester vaginal bleeding were referred for an early pregnancy assessment. The data from 204 patients were analysed. Two diagnostic models were constructed based on symptoms and the results of gynaecological examination to identify diagnostic subgroups relevant to clinical practice. Model 1, which separates viable pregnancies from other diagnoses, increased pre-test probability from 47% to a post-test probability of 70%. Model 2, which enabled the identification of complete miscarriages, resulted in a post-test probability of 41% of a complete miscarriage, given a pre-test sample probability of 25%. The tentative diagnosis of a general practitioner, based entirely on clinical judgement, turned out to be a poor predictor for the ultrasonographically confirmed diagnosis (pre-test probability of 47% changed to a post-test probability of 58%). This study shows that, in first trimester bleeding, neither statistical prediction models based on signs and symptoms, nor clinical judgement, are valid replacements for ultrasonographic assessment in establishing a diagnosis.
Carcinogenesis, 2003
Background: Expectant management is an alternative for curettage in women with a miscarriage. Aim... more Background: Expectant management is an alternative for curettage in women with a miscarriage. Aim: To assess the pattern of vaginal bleeding and pain in expectantly managed women with a miscarriage, and to analyse the factors predictive of a relatively quick spontaneous loss of pregnancy. Design of study: Part of a study comparing expectant management with surgical evacuation. Setting: Two hospitals in Amsterdam.
Obstetrical and Gynecological Survey
Ectopic pregnancy occurs in about 1% of pregnant women. This early pregnancy complication may be ... more Ectopic pregnancy occurs in about 1% of pregnant women. This early pregnancy complication may be life-threatening and adversely affect future fertility. The ability to diagnose this condition before it has deteriorated has changed it from a life-threatening disease into a more benign manageable one. This article reviews changes during the past century in the diagnostic and therapeutic management of ectopic pregnancies. At the beginning of the 20th century, the first diagnostic tool was surgery, initially laparotomy. With the adoption of laparoscopy as a mainstream gynecology procedure decades later, the diagnosis became timelier and less morbid. In the 1970s, a nonsurgical diagnostic strategy was developed to manage ectopic pregnancies using a combination of high-resolution ultrasonography and sensitive serum human chorionic gonadotropin (hCG) assays. Advances in diagnostic ultrasonography have resulted in expansion of the diagnosis ectopic pregnancy into multiple categories related...
European journal of obstetrics, gynecology, and reproductive biology, Jan 17, 2015
To study the impact on health-related quality of life (HRQoL) of treatment with systemic methotre... more To study the impact on health-related quality of life (HRQoL) of treatment with systemic methotrexate (MTX) or expectant management in women with ectopic pregnancy or pregnancy of unknown location (PUL) with low and plateauing serum hCG concentrations. HRQoL was assessed alongside a randomized clinical trial (RCT) with the use of standard self-administered psychometric measure questionnaires. All women who participated in the multicenter RCT comparing treatment with systemic MTX to expectant management in women with ectopic pregnancy or persisting PUL were eligible for the HRQoL measurements. HRQoL measures of three standardized questionnaires (SF-36, RSCL, HADS). Data were available for 64 of 73 women (78%) randomized in the RCT. We found no difference in HRQoL between the two treatment groups. The need for additional treatment, i.e. additional MTX injections or surgical intervention, had no impact on HRQoL. Women treated with MTX or expectant management for an ectopic pregnancy or...
American journal of hypertension, Jan 4, 2015
Creatine kinase (CK) is a main predictor of blood pressure, and this is thought to largely depend... more Creatine kinase (CK) is a main predictor of blood pressure, and this is thought to largely depend on high resistance artery contractility. We previously reported an association between vascular contractility and CK in normotensive pregnancy, but pregnancy is a strong CK inducer, and data on human hypertension are lacking. Therefore, we further explored CK-dependency of vascular contractility outside the context of pregnancy in normotensive and hypertensive women. Nineteen consecutive women, mean age 42 years (SE 1.3), mean systolic/diastolic blood pressure respectively 142.6 (SE 5.9)/85.6 (3.4) mm Hg (9 hypertensive), donated an omental fat sample during abdominal surgery. We compared vasodilation after the specific CK inhibitor 2,4-dinitro-1-fluorobenzene (DNFB; 10(-6) mol/l) to sodium nitroprusside (10(-6) mol/l) in isolated resistance arteries using a wire myograph. Additionally, we assessed predictors of vasoconstrictive force. DNFB reduced vascular contractility to 24.3% (SE 4....
Obstetrics and Gynecology International, 2014
Objectives. To survey practice variation in the management of first trimester miscarriage in The ... more Objectives. To survey practice variation in the management of first trimester miscarriage in The Netherlands. Methods. We sent an online questionnaire to gynecologists in eight academic, 37 nonacademic teaching, and 47 nonteaching hospitals. Main outcome measures were availability of a local protocol; estimated number of patients treated with curettage, misoprostol, or expectant management; misoprostol regimen; and estimated number of curettages performed after initial misoprostol treatment. Outcomes were compared to the results of a previous nationwide survey. Results. The response rate was 100%. A miscarriage protocol was present in all academic hospitals, 68% of nonacademic teaching hospitals, and 38% of nonteaching hospitals ( = 0.008). Misoprostol was first-choice treatment for 41% of patients in academic hospitals versus 34% and 27% in teaching-and nonteaching hospitals ( = 0.045). There were 23 different misoprostol regimens. Curettage was first-choice treatment in 29% of patients in academic hospitals versus 46% and 50% in nonacademic teaching or nonteaching hospitals ( = 0.007). In 30% of patients, initial misoprostol treatment was followed by curettage. Conclusions. Although the percentage of gynaecologists who are aware of the availability of misoprostol for miscarriage treatment has doubled to almost 100% since 2005, practice variation is still large. This practice variation underlines the need for a national guideline.
Reproductive BioMedicine Online, 2015
In this observational study, the effect of the introduction of the first Early Pregnancy Assessme... more In this observational study, the effect of the introduction of the first Early Pregnancy Assessment Unit (EPAU) in a university hospital in The Netherlands in 2008 on early pregnancy care is analysed. Derivatives of quality of care were measured before and after the establishment of the EPAU, with the aim of reducing unnecessary care. Care within three time periods was measured: 2006, 2009 and 2012. In 2006, 14% of women who had experienced a miscarriage were admitted to the hospital, whereas in 2009 and 2012 no women were admitted. The surgical management rate for miscarriage decreased from 79% (2006) to 6% (2009) and 28% (2012). Karyotyping of couples who had experienced recurrent miscarriage decreased from 100% (2006) to 17% (2009) and 33% (2012). The surgical management rate for ectopic pregnancy decreased from 50% (2006) to 25% (2009) and 29% (2012). The mean total cost per woman treated in 2006 was €1111 (95% CI €808 to 1426), €436 (95% CI €307 to 590) in 2009 and €633 (95% CI €586 to 788) in 2012. We can therefore conclude that an EPAU results in higher quality and cost-effective care, and has a positive effect on early pregnancy care.
Journal of Laparoendoscopic & Advanced Surgical Techniques
The balloon dilator is used in a variety of minimally invasive preperitoneal and retroperitoneal ... more The balloon dilator is used in a variety of minimally invasive preperitoneal and retroperitoneal operations. In this study, we compared the ability to create an extraperitoneal cavity using a balloon spacer in patients with and without previous abdominal surgery undergoing laparoscopic bladder neck suspension. This prospective study included 38 patients in total, 15 of whom had had previous abdominal wall surgery and 23 who had not. A balloon spacer technique was used to develop the extraperitoneal space. In 80% of the patients with previous surgery, the introduction of the balloon spacer was recorded as simple; in 20%, it was considered difficult. In 78% of the patients without previous surgery, the introduction of the balloon spacer was recorded as simple, in 17% it was difficult, and in 4% it failed. In 80% of the patients with previous surgery, the extraperitoneal view was good or acceptable, in 20% it was poor, and in 13% it failed. In 92% of the patients without previous surge...
Gastroenterology, 2002
BACKGROUND: Expectant management, although less effective, is an alternative treatment option for... more BACKGROUND: Expectant management, although less effective, is an alternative treatment option for surgical evacuation in women with a miscarriage. We assessed health-related quality of life (HRQL) differences over time between expectant and surgical management in women with a miscarriage. METHODS: Women with a miscarriage were randomized to either expectant (n 64) or surgical (n 58) management, and 305 eligible women
Nederlands tijdschrift voor geneeskunde, 2014
Miscarriage is the most common complication during the first trimester of pregnancy. Three treatm... more Miscarriage is the most common complication during the first trimester of pregnancy. Three treatment options are available for women who experience early miscarriage: expectant management, curettage, or medical treatment. Curettage has traditionally been the usual treatment, but both expectant management and medical management with misoprostol are more cost-effective. Curettage increases the risk of surgical complications and intra-uterine adhesions (Asherman syndrome), and is associated with preterm birth. After adequate counselling, the woman's preference is a decisive factor; the choice of treatment for early miscarriage lends itself ideally to shared decision making. The Netherlands lacks a multidisciplinary guideline on the treatment of women following miscarriage.
Nederlands tijdschrift voor geneeskunde, 2009
Problems in the first trimester of pregnancy frequently occur. Examples are miscarriage, ectopic ... more Problems in the first trimester of pregnancy frequently occur. Examples are miscarriage, ectopic pregnancy and recurrent miscarriage. In Dutch hospitals there is a growing interest in the setting up of 'early pregnancy units' (EPUs). The aim of these EPUs is to improve the quality of care for women with early pregnancy problems by centralising the care and knowledge available. This centralisation could prevent over- and underdiagnosis and over- and undertreatment. Moreover, EPUs could improve the logistics of clinical research. The potential effectiveness of these units in the Netherlands still needs to be investigated.
European Journal of Obstetrics & Gynecology and Reproductive Biology, 2015
The volume of a fibroid uterus before performing hysterectomy is typically estimated through bima... more The volume of a fibroid uterus before performing hysterectomy is typically estimated through bimanual examination and confirmed by ultrasonography. This study compares estimated volumes by bimanual examination and ultrasound examination with MRI and actual volumes obtained from histopathology, as gold standards. We used data from a previous prospective randomized multi-center trial that compared hysterectomy and uterine artery embolization (UAE) for the treatment of symptomatic fibroids. All patients underwent bimanual vaginal examination and pelvic ultrasonography. Those women randomized to UAE received a pelvic MRI. For women randomized to hysterectomy, the exact uterine volume was based on histopathologic examination. We compared the calculated volumes based on ultrasound parameters and estimated volume based on bimanual examination with either the calculated volumes of the pelvic MRI parameters or the calculated volume based on the exact weight during histological examinations. Our study demonstrated poor agreement between ultrasound and bimanual examination compared with exact volume during histopathologic examination and MRI-based volume. The agreement within the patient group with uterine volume >233 g and >747 g was fair to good. For those women with a uterine volume between 233 and 747 g, the agreement was poor when comparing bimanual estimates with volume obtained from MRI or histolopathologic examination. Within this volume group, the agreement on uterine volume between ultrasound and MRI or histopathologic examination was fair. Our study shows that uterine volume as estimated by ultrasound and bimanual examination can be used for small or large uteri. For uteri with an intermediate volume, bimanual examination and ultrasound are less reliable.
American Journal of Hypertension, 2014
Female-specific risk factors for cardiovascular disease are understudied. We assessed whether wom... more Female-specific risk factors for cardiovascular disease are understudied. We assessed whether women with uterine fibroids have a greater hypertension risk, independent of the shared risk factors for both conditions.
The Lancet, 2014
Background Tubal ectopic pregnancy can be surgically treated by salpingectomy, in which the aff e... more Background Tubal ectopic pregnancy can be surgically treated by salpingectomy, in which the aff ected Fallopian tube is removed, or salpingotomy, in which the tube is preserved. Despite potentially increased risks of persistent trophoblast and repeat ectopic pregnancy, salpingotomy is often preferred over salpingectomy because the preservation of both tubes is assumed to off er favourable fertility prospects, although little evidence exists to support this assumption. We aimed to assess whether salpingotomy would improve rates of ongoing pregnancy by natural conception compared with salpingectomy.