Major abdominal surgery frequently leads to peritoneal dialysis (PD) dropout and technique failure, owing to complications that compromise the integrity of the abdominal wall or the peritoneal cavity. We report the first case of an uncomplicated robotic-assisted laparoscopic total hysterectomy for endometrial cancer (EC) in a 46-year-old PD patient with clinical obesity (Body Mass Index 38 kg/m2). Following a short-term planned transfer to hemodialysis in the immediate postoperative period, she was able to resume her regular PD regime, demonstrating that technique survival is feasible despite major surgery and multiple risk factors. This case demonstrates that robotic surgery can be safely performed in a PD patient with endometrial cancer, when supported by careful planning and close interdisciplinary collaboration.

We report the case of a 32-year-old pregnant woman who presented at 9 weeks of gestation with severe hyperemesis gravidarum (HG) and metabolic disturbances. Biochemical testing revealed hypercalcemia with an inappropriately elevated parathyroid hormone (PTH) level. Subsequent imaging identified a parathyroid adenoma. This case highlights primary hyperparathyroidism as a rare but important differential diagnosis in refractory HG and underscores the diagnostic challenges of interpreting calcium and PTH values during pregnancy.

Background Myocarditis is an inflammatory cardiomyopathy with broad clinical spectrum. Pregnancy outcomes in women with a history of myocarditis are not well described. Purpose The aim of this study is to determine maternal and fetal outcomes in pregnant women with history of myocarditis/perimyocarditis. Methods This was a retrospective study of pregnancy outcomes in patients with prior history of myocarditis/perimyocarditis followed in a CardioObstetrics Program (1998-2025). Adverse maternal cardiac outcomes included: maternal death, heart failure, and sustained arrhythmia. Echocardiographic changes during pregnancy were examined. Fetal adverse events: fetal death, prematurity, small for gestational age (<10th percentile). Results Thirty-six pregnancies in women (n=27) with a history of myocarditis were included [mean age 33±4.9 years, median interval between myocarditis and pregnancy 5.0 years]. In 50% of cases, there was moderate/severe left ventricular (LV) systolic dysfunction at time of myocarditis presentation. In most (83%,15/18) pregnancies, with significant LV dysfunction at time of myocarditis presentation, there was full recovery of LV systolic function prior to pregnancy. No adverse maternal cardiac events were reported in 97% (35/36) of pregnancies. One patient with moderately reduced LV systolic function during myocarditis, with recovery prior to pregnancy, developed heart failure. Two patients had reduction in LV systolic function in pregnancy, from mild/normal to moderate/severely reduced. There were no maternal or fetal deaths. Thirteen percent of pregnancies had premature delivery (31-36 weeks). Conclusion Most women with prior myocarditis do not develop adverse cardiac events. However, echocardiographic surveillance during pregnancy may still be helpful to identify decreases in LV systolic function.

Cardiovascular disease (CVD) is the leading cause of death and the mortality rate and prognosis of CVD in women are worse compared to men. Adverse Pregnancy Outcomes (APOs) are frequently overlooked sex-specific risk factors for CVD and affect up to one in five pregnant women. This study evaluated healthcare providers'(HCPs) awareness of the long-term cardiovascular risk associated with gestational diabetes mellitus and hypertensive disorders of pregnancy. A cross-sectional survey was conducted in Austria between March and August 2022 to assess HCPs’ knowledge, follow-up recommendations, and counseling regarding cardiovascular risk following APOs. The respondents were divided into general medicine, Obstetrics and Gynecology (O G), general internal medicine, and cardiology. Of the 175 responses, 20

Importance: Inadequate management of elevated blood pressure (BP) is a significant contributing factor to maternal deaths. Self-monitoring of BP in the general population has been shown to improve the diagnosis and management of hypertension; however, little is known about its use in pregnancy. Objective: To determine whether selfmonitoring of BP in higher-risk pregnancies leads to earlier detection of pregnancy hypertension. Design, setting, and participants: Unblinded, randomized clinical trial that included 2441 pregnant individuals at higher risk of preeclampsia and recruited at a mean of 20 weeks' gestation from 15 hospital maternity units in England between November 2018 and October 2019. Final follow-up was completed in April 2020. Interventions: Participating individuals were randomized to either BP selfmonitoring with telemonitoring (n = 1223) plus usual care or usual antenatal care alone (n = 1218) without access to telemonitored BP. Main outcomes and measures: The primary outcome was time to first recorded hypertension measured by a health care professional. Results: Among 2441 participants who were randomized (mean [SD] age, 33 [5.6] years; mean gestation, 20 [1.6] weeks), 2346 (96%) completed the trial. The time from randomization to clinic recording of hypertension was not significantly different between individuals in the self-monitoring group (mean [SD], 104.3 [32.6] days) vs in the usual care group (mean [SD], 106.2 [32.0] days) (mean difference,-1.6 days [95% CI,-8.1 to 4.9]; P = .64). Eighteen serious adverse events were reported during the trial with none judged as related to the intervention (12 [1%] in the selfmonitoring group vs 6 [0.5%] in the usual care group). Conclusions and relevance: Among pregnant individuals at higher risk of preeclampsia, blood pressure selfmonitoring with telemonitoring, compared with usual care, did not lead to significantly earlier clinic-based detection of hypertension. Trial registration: ClinicalTrials.gov Identifier: NCT03334149

Background: Adverse pregnancy outcomes (APO), including preeclampsia (PE) and gestational diabetes mellitus (GDM), increase the future risk of developing cardiometabolic disease (CMD), such as cardiovascular disease and type 2 diabetes mellitus (T2DM). CVD is the leading cause of death among women. Despite the well-established relationship between APO and CMD, women’s awareness is limited. We aimed to assess and compare risk perception for future CMD among women with PE and GDM. Methods: Women diagnosed with PE and GDM between 2015 and 2020 at the University Hospital St. Pölten were identified. Telephone interviews were conducted to assess women’s risk perception of future CMD. Results: Of the 161 women included in the study, approximately half had a high risk perception of future CMD. Women with PE (n = 46) were less aware of their long-term risks than those with GDM (n = 115), and 43.5% were unaware of any association between APO and CMD. Risk perception increased among all the participants when they considered their future CMD risk without lifestyle changes. Women with high risk perceptions were three times more likely to plan on modifying their lifestyle behaviors in the future to mitigate their CMD risk. Conclusion: This study demonstrated a lack of risk perception for future CMD among women with APO, underscoring the need for improved patient education during and after pregnancy. To increase risk perception, it is crucial to educate women about the long-term risks associated with APO, emphasize the severity of CMD, and promote lifestyle interventions.

OBJECTIVE:To investigate fetal/neonatal and obstetric events in pregnancies with both maternal and fetal heart disease. STUDY DESIGN:From the CARPREG database, singleton pregnancies (>24 weeks) in patients with structural heart disease that underwent fetal/neonatal echocardiograms were selected and separated in two groups: maternal heart disease only (M-HD) and maternal and fetal heart disease (MF-HD). Differences in adverse fetal/neonatal (death, preterm birth, and small for gestational age) and obstetric (preeclampsia/eclampsia) outcomes between groups were analyzed. RESULTS:From 1011 pregnancies, 93 had MF-HD. Fetal/neonatal events (38.7% vs 25.3%, p = 0.006) and spontaneous preterm birth (10.8% vs 4.9%, p = 0.021) were more frequent in MF-HD compared to M-HD, with no difference in obstetric events. MF-HD remained as a significant predictor of fetal/neonatal events after adjustment (OR:1.883; 95% CI:1.182-3.000; p = 0.008). CONCLUSIONS:Pregnancies with MF-HD are at risk of adverse fetal/neonatal events and spontaneous preterm birth. Larger studies are needed to determine their association with preeclampsia.

Summary Background Adverse pregnancy outcomes (APO), such as preeclampsia (PE) and gestational diabetes (GDM) are substantial risk factors for cardiovascular disease (CVD) later in life. Identifying these high-risk female individuals during pregnancy offers the possibility of preventing long-term CVD and chronic kidney disease via a structured therapeutic and surveillance plan. We aimed to evaluate the current practice of postpartum care in women after APO and the impact on the women’s awareness about their future risk for CVD. Methods Women diagnosed with PE and GDM at the University Hospital of St. Poelten/Lilienfeld between 2015–2020 were identified and participated in a structured telephone interview about postpartum medical care and knowledge about the impact of APOs on long-term cardiovascular health. Results Of 161 out of the 750 women contacted, 29% ( n = 46) were diagnosed with PE and 71% ( n = 115) with GDM. One third of all women and up to 44% of women diagnosed with PE, were unaware that APOs are related to CVD. Women diagnosed with PE were less likely to receive postpartum care information than those with GDM (30.4% vs. 49.6%, p = 0.027), and only one third of all women after APOs were counselled by a physician or healthcare professional. Of the women 50% received recommendations regarding lifestyle changes after delivery; significantly more women with GDM than women with PE (54% vs. 37%, p = 0.05). Only 14% had at least one long-term follow-up. Conclusion This study identified a significant deficit of structured postpartum care and a lack of awareness among women after APO and their healthcare providers about the increased risk of long-term CVD.

BACKGROUND:Although pregnancy outcomes in women with normally functioning bioprosthetic valves (BPVs) are often good, structural valve dysfunction (SVD) may adversely affect pregnancy outcomes, but this has not been studied.OBJECTIVES:The aim of this study was to examine outcomes in pregnant women with BPVs and the association with SVD.METHODS:Pregnancy outcomes in women with BPVs were prospectively collected. Adverse maternal cardiac events (CEs) included cardiac death or arrest, sustained arrhythmia, heart failure, thromboembolism, and stroke. Adverse fetal events were also studied. Determinants of adverse events were examined using logistic regression.RESULTS:Overall, 125 pregnancies in women with BPVs were included, 27% with left-sided and 73% with right-sided BPV. SVD was present in 27% of the pregnancies (44% with left-sided BPVs vs 21% with right-sided BPVs; P = 0.009). CEs occurred in 13% of pregnancies and were more frequent in women with SVD compared with those with normally functioning BPVs (26% vs 8%; P = 0.005). CEs were more common in women with left-sided BPVs with SVD vs normally functioning BPVs (47% vs 5%; P = 0.01) but not in women with right-sided BPVs (11% in those with SVD vs 8% in those without SVD; P = 0.67). Left-sided SVD (P = 0.007), maternal age >35 years (P = 0.001), and a composite variable of "high-risk" features (P = 0.006) were predictors of CEs. Fetal events occurred in 28% of pregnancies.CONCLUSIONS:In this cohort of young women with BPVs, SVD was present in 27% at the first antenatal visit and negatively affected pregnancy outcomes. In particular, SVD of left-sided BPVs was associated with high rates of adverse outcomes.

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Allergic diseases like asthma, allergic rhinitis, or food allergy have a high prevalence in women of childbearing age and may affect up to 30% of this age group. A multitude of immunological changes characterizes pregnancy to create the optimal milieu for the unborn child. Both these immunological changes and pre-conceptional, sub-optimal disease control may affect the severity of the respective allergic disease manifestations during pregnancy and pose a risk for mother and child. Due to apparent limitations in conducting clinical trials, safety data on anti-allergic drugs during pregnancy are limited. This lack of clinical evidence demands to counsel between potential and known risks and benefits of anti-allergic drugs. This includes the potential of disease aggravation in the absence of treatment. By doing so, informed decisions and shared decision-making is facilitated. In particular, in patients with severe asthma, education about the risk of uncontrolled asthma for mother and child should be part of regular care. This review focuses on the management of allergic diseases during pregnancy, maternal counseling, and available information/evidence regarding allergic diseases’ management and treatment during pregnancy. Furthermore, we discuss the challenges of treating patients with allergic diseases and covid-19 during pregnancy.

There has been an increase in maternal deaths from cardiovascular disease in many countries. In high-income countries, cardiovascular deaths secondary to cardiomyopathies, ischemic heart disease, sudden arrhythmic deaths, aortic dissection, and valve disease are responsible for up to one-third of all pregnancy-related maternal deaths. In low- and middle-income countries, rheumatic heart disease is a much more common cause of cardiac death during pregnancy. Although deaths occur in women with known heart conditions or cardiovascular risk factors such as hypertension, many women present for the first time in pregnancy with unrecognised heart disease or with de novo cardiovascular conditions such as preeclampsia, peripartum cardiomyopathy, spontaneous coronary artery dissection. Not only has maternal cardiovascular mortality increased, but serious cardiac morbidity, or "near misses," during pregnancy also have increased in frequency. Although maternal morbidity and mortality are often preventable, many health professionals remain unaware of the impact of cardiovascular disease in this population, and the lack of awareness contributes to inappropriate care and preventable deaths. In this review, we discuss the maternal mortality from cardiovascular causes in both high- and low- and middle-income countries and strategies to improve outcomes.

Biologicals have transformed the management of severe disease phenotypes in asthma, atopic dermatitis, and chronic spontaneous urticaria. As a result, the number of approved biologicals for the treatment of atopic diseases is continuously increasing. Although atopic diseases are among the most common diseases in the reproductive age, investigations, and information on half-life, pharmacokinetics defining the neonatal Fc receptors (FcRn) and most important safety of biologicals in pregnancy are lacking. Given the complex sequence of immunological events that regulate conception, fetal development, and the intrauterine and postnatal maturation of the immune system, this information is of utmost importance. We conducted a systematic review on biologicals in pregnancy for indications of atopic diseases. Evidence in this field is scarce and mainly reserved to reports on the usage of omalizumab. This lack of evidence demands the establishment of a multidisciplinary approach for the management of pregnant women who receive biologicals and multicenter registries for long-term follow-up, drug trial designs suitable for women in the reproductive age, and better experimental models that represent the human situation. Due to the very long half-life of biologicals, preconception counseling and healthcare provider education are crucial to offer the best care for mother and fetus. This position paper integrates available data on safety of biologicals during pregnancy in atopic diseases via a systematic review with a detailed review on immunological considerations how inhibition of different pathways may impact pregnancy.

Allergic diseases like asthma, allergic rhinitis, food allergy, hymenoptera allergy, or atopic dermatitis are highly prevalent in women of childbearing age and may affect up to 30% of this age group. This review focuses on the management of allergic diseases during pregnancy. Furthermore, we discuss the challenges of counseling women with allergic diseases in the reproductive age, including considerations relevant to the ongoing SARS-CoV-2 pandemic. To create the optimal milieu for the unborn child, a multitude of immunological changes occur during pregnancy which may favor type 2 responses and aggravate disease phenotypes. In co-occurrence with suboptimal preconception disease control, this elevated Th2 responses may aggravate allergic disease manifestations during pregnancy and pose a risk for mother and child. Due to limitations in conducting clinical trials in pregnant women, safety data on anti-allergic drugs during pregnancy are limited. The lack of information and concerns among pregnant patients demands counseling on the benefits of anti-allergic drugs and the potential and known risks. This includes information on the risk for mother and child of disease aggravation in the absence of treatment. By doing so, informed decisions and shared decision-making can take place.

Zurück zum Zitat Vasileiou E, Simpson CR, Robertson C, Shi T, Kerr S, Agrawal U et al. Effectiveness of First Dose of COVID-19 Vaccines Against Hospital Admissions in Scotland: National Prospective Cohort Study of 5.4 Million People. 2021; https://​papers.​ssrn.​com/​sol3/​papers.​cfm?​abstract_​id=​3789264 (zuletzt aufgerufen am 1.03.2021)

Summary Background The vaccines against the coronavirus disease 2019 (COVID-19) approved in the European Union represent a decisive step in the fight against the pandemic. The application of these available vaccines to patients with pre-existing immunological conditions leads to a multitude of questions regarding efficacy, side effects and the necessary patient information. Results This review article provides insight into mechanisms of action of the currently available severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines and summarises the current state of science as well as expert recommendations regarding tolerability of the vaccines. In addition, the potential to develop protective immune responses is determined. A special focus is given on patients under immunosuppression or in treatment with immunomodulatory drugs. Special groups of the population such as children, pregnant women and the elderly are also considered. Conclusion Despite the need for a patient-specific risk–benefit assessment, the consensus among experts is that patients with immunological diseases in particular benefit from the induced immune protection after COVID-19 vaccination and do not have an increased risk of side effects.

BACKGROUND Pregnancies in women with regurgitant valve lesions are generally considered low risk, but this has not been well studied. OBJECTIVES This study determined the frequency of adverse cardiac events (CEs) in pregnant women with moderate or severe regurgitant valve lesions. METHODS Maternal and fetal outcomes in women with moderate or severe chronic valve regurgitation enrolled in a prospective multicenter study on pregnancy outcomes were examined. Adverse CEs included heart failure, sustained arrhythmias, cardiac arrest, or death. A multivariate logistic regression model was used to identify determinants of CEs in women at the highest risk. RESULTS Outcomes of 430 pregnancies in women with moderate or severe regurgitant lesions were examined: 145 with mitral regurgitation (MR), 101 with pulmonary regurgitation (PR), 71 with multivalve disease, 73 with tricuspid regurgitation (TR), and 40 with aortic regurgitation (AR). Most women had associated congenital or acquired heart disease. Adverse CEs occurred in 13% of pregnancies: 27% of pregnancies with multivalve disease; 15% with MR; 15% with TR; 5% with AR; and 3% with PR. Maternal mortality was rare. In women with MR, TR, or multivalve disease (n = 289), left ventricular systolic dysfunction (p = 0.001), pulmonary hypertension (p = 0.005), and cardiac events before pregnancy (p < 0.001) were important determinants of CEs during pregnancy. CONCLUSIONS Women with AR and PR are at low risk for cardiac complications during pregnancy. While many women with MR, TR, and multivalve regurgitation do well during pregnancy, additional clinical variables help stratify those at highest risk. This new information will enhance the quality and precision of preconception counseling and pregnancy planning. (J Am Coll Cardiol 2021;77:2656-64) (c) 2021 by the American College of Cardiology Foundation.

BACKGROUND:Women with heart disease are at risk for complications during pregnancy. This study sought to examine the effect of maternal obesity on pregnancy complications in women with heart disease. OBJECTIVES:The objective was to determine the incidence of adverse cardiac events (CE) in pregnant women with heart disease and obesity. METHODS:Adverse CE during pregnancy were examined in a prospective cohort of women with heart disease. CE were a composite of the following: cardiac death/arrest, arrhythmias, heart failure, myocardial infarction, stroke, aortic dissection, and thromboembolic events. Pre-eclampsia and post-partum hemorrhage were also studied. Outcomes were examined according to body mass index (BMI). To identify additional predictors of CE, a baseline risk score (CARPREG [Canadian Cardiac Disease in Pregnancy Study] II score) for predicting cardiac complications was calculated for all pregnancies and included in a multivariable logistic regression model. RESULTS:Of 790 pregnancies, 19% occurred in women with BMI ≥30 kg/m2 (obesity), 25% in women with BMI 25 to 29.9 kg/m2 (overweight), 53% in women with BMI 18.5 to 24.9 kg/m2 (normal weight), and 3% in women with BMI <18.5 kg/m2 (underweight). Women with obesity were at higher risk of CE when compared with women with normal weight (23% vs. 14%; p = 0.006). In a multivariable model, obesity (odds ratio: 1.7; 95% confidence interval: 1.0 to 2.7) and higher CARPREG II risk scores (odds ratio: 1.7; 95% confidence interval: 1.5 to 1.9) predicted CE. Pre-eclampsia was more frequent in women with obesity compared with those with normal weight (8% vs. 2%; p = 0.001). CONCLUSIONS:Obesity increases the risk of maternal cardiovascular complications in pregnant women with heart disease. This modifiable risk factor should be addressed at the time of preconception counseling.