Background: Endometrial ablation (EA) is a frequently used treatment for abnormal uterine bleeding, mainly due to the low risks, low costs and short recovery time associated with the procedure. On the short term, it seems successful, long-term follow-up however, shows decreasing patient satisfaction as well as treament efficacy. There even is a postablation hysterectomy rate up to 21%. Multiple factors seem to`influence the outcome of EA. Due to dissimilarities in and variety of these factors, it has not been possible so far to predict the success rate of EA based on pre-operative factors. Therefore, the aim of this study is to develop two prediction models to help counsel patients for failure of EA or necessity of surgical re-intervention within 2 years after EA. Methods: We designed a retrospective two-centred cohort study in Catharina Hospital, Eindhoven and Elkerliek Hospital, Helmond, both non-university teaching hospitals in the Netherlands. The study population consisted of 446 pre-menopausal women who underwent EA for abnormal uterine bleeding, with a minimum follow-up time of 2 years. Multivariate logistic regression analysis was used to create the prediction models. Results: The mean age of the patients was 43.8 years (range 20-55), 97.3% had complaints of menorrhagia, 57.4% of dysmenorrhoea and 61.0% had complaints of intermittent or irregular bleeding. 18.8% of patients still needed a hysterectomy after EA. The risk of re-intervention was significantly greater in women with menstrual duration > 7 days or a previous caesarean section, while pre-operative menorrhagia was significantly associated with success of EA. Younger age, parity ≥ 5 and dysmenorrhea were significant multivariate predictors in both models. These predictors were used to develop prediction models, which had a C-index of 0.71 and 0.68 respectively. Conclusion: We propose two multivariate models to predict the chance of failure and surgical re-intervention within 2 years after EA. Due to the permanent character of EA, the increasing number of post-operative failure and re-interventions, these prediction models could be useful for both the doctor and patient and may contribute to the shared decision-making.

With an growing number of people on a strict plant-based diet, its potential effect on pregnancy and lactation becomes increasingly important. It is, however, unclear how obstetric caregivers currently handle and think about a strict plant-based diet in pregnancy. The aim of the study was therefore to evaluate the self-reported knowledge and advice given by Dutch obstetric caregivers and dietitians when treating pregnant women on a strict plant-based diet. A cross-sectional study was performed by sending an online survey to Dutch midwife practices, obstetricians, and dietitian practices. Descriptive statistics are reported. A total of 121 midwives, 179 obstetricians, and 111 dietitians participated in this study. The majority of midwives (80.2%) and obstetricians (93.9%) considered a strict plant-based diet to be a significant risk factor for nutrient deficiency during pregnancy. Maternal dietary preferences, including a potential strict plant-based diet, were discussed at the first prenatal appointment by 59.5% of midwives and 24.1% of obstetricians. A self-reported lack of knowledge concerning the strict plant-based diet was mentioned by 66.1% of midwives and 75.4% of obstetricians. Obstetric caregivers mostly considered the identification of this dietary habit and subsequent referral to a dietitian or a reliable website as optimal care for pregnant women on the strict plant-based diet. However, only 38.7% of dietitians indicated to have sufficient knowledge to counsel these women. Although obstetric caregivers thought that a strict plant-based diet in pregnancy may lead to increased risks of nutritional deficiencies, the majority report to have insufficient knowledge to provide adequate advice. Only a minority referred these women to dietitians, of whom a minority indicated to have adequate knowledge on this specific diet. These results suggest that current care is suboptimal for an increasing number of pregnant women. Women on a strict plant-based diet could benefit from increased knowledge about this topic among obstetric caregivers and dietitians, as well as from clear guidelines regarding this diet during pregnancy.

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