Charlotta Grunewald

Detection of malformations in chromosomally normal fetuses by routine ultrasound at 12 or 18 weeks of gestation : a randomised controlled trial in 39 572 pregnancies

Objective  To compare the antenatal detection rate of malformations in chromosomally normal fetuses between a strategy of offering one routine ultrasound examination at 12 gestational weeks (gws) and a strategy of offering one routine examination at 18 gws.

Severe asphyxia due to delivery‐related malpractice in Sweden 1990–2005

Objective  To describe possible causes of delivery‐related severe asphyxia due to malpractice.

Ultrasound dating at 12–14 weeks of gestation. A prospective cross‐validation of established dating formulae in in‐vitro fertilized pregnancies

To determine the accuracy of established ultrasound dating formulae when used at 12–14 weeks of gestation.

Change in estimated cerebral perfusion pressure after treatment with nimodipine or magnesium sulfate in patients with preeclampsia

OBJECTIVE Data are accumulating to suggest that cerebral perfusion pressure may be either abnormally high or low in preeclampsia and eclampsia. Little is known of the cerebral perfusion pressure effects of magnesium sulfate or nimodipine. Our objective in this study was to compare the change in cerebral perfusion pressure in patients with severe preeclampsia randomly selected to receive nimodipine or magnesium sulfate. STUDY DESIGN Patients with severe preeclampsia were randomly selected to receive magnesium sulfate (6 g bolus and 2 g/hr intravenous infusion) or nimodipine (60 mg taken orally every 4 hours). Transcranial Doppler ultrasonography was used to measure flow velocities in the right and left middle cerebral arteries, and the results were averaged. Measurements were obtained before treatment (baseline) and 30 minutes after the magnesium sulfate bolus was completely infused or 30 minutes after the nimodipine was ingested. Studies were performed before any other intervention. The person performing the ultrasonography was unaware of the patients group assignment. Estimated cerebral perfusion pressure was calculated with the following formula: Estimated cerebral perfusion pressure = Velocity(mean) x [(Blood pressure(mean ) - Blood pressure(diastolic ))/(Velocity(mean) - Velocity(diastolic ))]. The difference between estimated cerebral perfusion pressure at baseline and after treatment was compared between the 2 groups by means of the Mann-Whitney rank sum test. RESULTS Nine patients were randomly selected to receive nimodipine and 12 to receive magnesium sulfate. Patient demographics and severity of condition were not significantly different between the 2 groups. The change in estimated cerebral perfusion pressure was significantly different between the groups. Estimated cerebral perfusion pressure increased after nimodipine use and decreased after magnesium sulfate use. CONCLUSION Shortly after administration to patients with severe preeclampsia, nimodipine resulted in increased cerebral perfusion pressure in comparison with magnesium sulfate.

Effects of nitroglycerin on the uterine and umbilical circulation in severe preeclampsia

Objective To determine the effects of nitroglycerin on placental circulation in severe preeclampsia. Methods Twelve women with severe preeclampsia were examined. Uterine and umbilical artery pulsatility indices (PI) were assessed by pulsed Doppler ultrasound before and after infusion of nitroglycerin, starting at 0.25 μg/kg per minute with stepwise dosage increases until a diastolic blood pressure (BP) of 100 mmHg was achieved. Blood pressure and heart rate were recorded every 5 minutes. Blood was sampled for analysis of the second messenger of nitric oxide, cyclic guanosine monophosphate (cGMP), before and at the end of the infusion. Results During the infusion, the mean systolic BP de-creased from 161 (95% confidence interval [CI] 154–169) to 138 mmHg (95% CI 131–146), and the diastolic pressure decreased from 116 (95% CI 111–122) to 103 (95% Cl 96–110) mmHg (P < .01). The PI of the uterine artery did not change significantly (1.23 [95% CI 1.01–1.61]) versus 1.30 [95% CI 1.01–1.88]), whereas umbilical artery PI decreased significantly (P < .01), from 1.35 (95% CI 1.09–1.73) to 1.20 (95% CI 1.05–1.40), with a more pronounced decrease in patients with high basal values. Cyclic GMP remained essentially unchanged (6.4 [95% CI 5.4–7.71 versus 5.5 [4.7–6.6] nmol/L). Conclusion The reduction in the PI of the umbilical artery during nitroglycerin-induced BP reduction implies vasodilation in the umbilical circulation. The absence of an increase in cGMP does not support the view that the nitroglycerin effect is reflected by the plasma concentration of cGMP.

Association of cerebral perfusion pressure with headache in women with pre-eclampsia

Objective To study estimated cerebral perfusion pressure and its relation to headache and scotomata in women with pre‐eclampsia.

Routine ultrasound examination at 12 or 18 gestational weeks for prenatal detection of major congenital heart malformations? A randomised controlled trial comprising 36 299 fetuses.

Objective  To compare the rate of prenatal diagnosis of heart malformations between two policies of screening for heart malformations.

Does fetal screening affect women's worries about the health of their baby? : a randomized controlled trial of ultrasound screening for Down's syndrome versus routine ultrasound screening

Background.  Screening for fetal abnormality may increase womens anxiety as attention is directed at the possibility of something being wrong with the baby. The aim of this study was to evaluate the effect of ultrasound screening for Downs syndrome on womens anxiety in mid‐pregnancy and 2 months after delivery.

Changes in flow velocity, resistance indices, and cerebral perfusion pressure in the maternal middle cerebral artery distribution during normal pregnancy

Background. There are few longitudinal data currently available detailing the normal changes in maternal cerebral hemodynamics during human pregnancy. This lack of information limits the study of pregnancy‐associated cerebrovascular adjustments and, in particular, preeclampsia, where the brain appears to be especially susceptible to ischemic and encephalopathic injury. Our objective was to define the hemodynamic changes, specifically velocity, resistance indices, and cerebral perfusion pressure, in the middle cerebral artery (MCA) distribution of the brain during normal pregnancy.

Safety of birth centre care: perinatal mortality over a 10-year period

Objective  To study perinatal mortality in women booked for birth centre care during pregnancy.