Elisabeth Krampl-Bettelheim

Prevention of preterm delivery in twin gestations (PREDICT): a multicenter, randomized, placebo‐controlled trial on the effect of vaginal micronized progesterone

Studies on high‐risk singleton gestations have shown a preventive effect of progesterone treatment on preterm delivery. This study was conducted to investigate the preventive effect of vaginal micronized progesterone in a large population of twin gestations.

Vaginal micronized progesterone and risk of preterm delivery in high-risk twin pregnancies: secondary analysis of a placebo-controlled randomized trial and meta-analysis

Progesterone treatment reduces the risk of preterm delivery in high‐risk singleton pregnancies. Our aim was to evaluate the preventive effect of vaginal progesterone in high‐risk twins.

What does magnetic resonance imaging add to the prenatal ultrasound diagnosis of facial clefts

Ultrasound is the modality of choice for prenatal detection of cleft lip and palate. Because its accuracy in detecting facial clefts, especially isolated clefts of the secondary palate, can be limited, magnetic resonance imaging (MRI) is used as an additional method for assessing the fetus. The aim of this study was to investigate the role of fetal MRI in the prenatal diagnosis of facial clefts.

First-trimester fetal heart rate in mothers with opioid addiction

AIM To investigate the difference in fetal heart rate of opioid-dependent mothers compared to non-dependent mothers in the first trimester of pregnancy. DESIGN The data of 74 consecutive singleton pregnancies of mothers enrolled in a maintenance programme for opioid-dependent women was matched to 74 non-exposed singleton pregnancies by maternal age, crown-rump length, smoking status, ethnic background and mode of conception. MEASUREMENT Fetal heart rate measured as part of first-trimester screening by Doppler ultrasound between 11+0 and 13+6 gestational weeks was compared retrospectively. FINDINGS The mean fetal heart rate in opioid-dependent mothers was 156.0 beats per minute (standard deviation 7.3) compared to 159.6 (6.5) in controls. The difference in fetal heart rate was significant (P = 0.02). There was a significant difference in mean maternal body mass index (P = 0.01) but not in mean nuchal translucency (P = 0.3), gestational age (0.5), fetal gender (P = 0.3) and parity (P = 0.3) between both groups. Fifty-five per cent (41 of 74) of cases were taking methadone, 30% (22 of 74) buprenorphine and 15% (11 of 74) were taking slow-release morphines throughout the pregnancy. CONCLUSIONS In fetuses of opioid-dependent mothers a decreased fetal heart rate can already be observed between 11+0 and 13+6 gestational weeks. The effect of opioid intake needs to be taken into consideration when interpreting fetal heart rate in opioid-dependent mothers at first-trimester screening.

Cytokines and the risk of preterm delivery in twin pregnancies.

OBJECTIVE: To estimate the association between cytokine levels in twin pregnancies and risk of spontaneous preterm delivery, including the effect of progesterone treatment. METHODS: This secondary analysis of a randomized placebo-controlled trial investigating the effect of progesterone treatment on preterm delivery in twin pregnancies included 523 women with available dried blood spot samples collected before treatment with progesterone (n=258) or placebo (n=265) and after 4–8 weeks of treatment. Samples were analyzed for cytokines using a sandwich immunoassay. Cytokine levels in spontaneous preterm delivery at 34–37 weeks of gestation and spontaneous preterm delivery before 34 weeks of gestation were compared with delivery at 37 weeks of gestation or more for placebo-treated women. The association between interleukin (IL)-8 and risk of spontaneous preterm delivery before 34 weeks of gestation was estimated further, including comparison according to treatment. Statistical analyses included Kruskal-Wallis test, Mann-Whitney U test, linear regression, and Cox regression analysis. RESULTS: We found a statistically significant association between IL-8 and spontaneous preterm delivery. At 23–33 weeks of gestation, the median IL-8 level was 52 pg/mL (interquartile range 39–71, range 19–1,061) for term deliveries compared with 65 pg/mL (interquartile range 43–88, range 14–584) for spontaneous preterm delivery at 34–37 weeks of gestation and 75 pg/mL (interquartile range 57–102, range 22–1,715) for spontaneous preterm delivery before 34 weeks of gestation (P<.001). Risk of spontaneous preterm delivery was associated with a large weekly increase in IL-8 (hazard ratio 2.0, 95% confidence interval [CI] 1.2–3.3). There was no effect of progesterone treatment on IL-8 levels. Levels of IL-8 at 18–24 weeks of gestation were associated with a cervix less than 30 mm (odds ratio 1.8, 95% CI 1.2–2.7). CONCLUSION: Risk of spontaneous preterm delivery before 34 weeks of gestation is increased in women with high IL-8 levels. Progesterone treatment does not affect IL-8 levels. CLINICAL TRIAL REGISTRATION: EudraCT, https://eudract.ema.europa.eu, 2006-000503-41, and ClinicalTrials.gov, www.clinicaltrials.gov, NCT00329914. LEVEL OF EVIDENCE: II

Congenital heart disease in monochorionic twins with and without twin-to-twin transfusion syndrome

This study aims to evaluate the prevalence of congenital heart disease (CHD) in monochorionic (MC) twin pregnancies with and without twin‐to‐twin transfusion syndrome (TTTS) in an unselected cohort, which underwent prenatal and postnatal echocardiography.

Short- and long-term perinatal outcome in twin pregnancies affected by weight discordance

The objective was to investigate the association between chorionicity‐specific intertwin birthweight discordance and adverse outcomes including long‐term follow up at 6, 18, and 48–60 months after term via Ages and Stages Questionnaire.

Influence of gestational diabetes mellitus on weight discrepancy in twin pregnancies.

OBJECTIVE To evaluate the influence of gestational diabetes mellitus on weight discrepancy in twin pregnancies. METHODS 200 twin pregnancies were included in the study. 157 nondiabetic pregnant women with twin gestations and 43 twin pregnancies with gestational diabetes mellitus (GDM) with viable fetuses born after 24 weeks of gestation were enrolled. Influence of maternal age, body-mass-index at the time of the oral glucose tolerance test, parity, smoking, chorionicity, gestational age at delivery and diagnosis of GDM on weight discrepancy of the twins was evaluated. RESULTS Mean weight discrepancy of all analyzed twin pregnancies was 285 grams (+/- 231), relative weight discrepancy was 11.3% (+/- 8.6). Univariate regression analyses showed that GDM, chorionicity and gestational age at delivery were significantly associated with weight discrepancy. In the multivariate model only diagnosis of GDM was significantly associated with weight discrepancy. CONCLUSION Twin pregnancies with insulin requiring gestational diabetes seem to have less birth weight discrepancy than twin pregnancies with normal glucose tolerance.

OC01.01: Prevention of preterm delivery in twin gestations (PREDICT): a multicentre randomised placebo-controlled trial on the effect of vaginal micronised progesterone: Oral communication abstracts

L. Rode1,2, K. Klein3, K. Nicolaides4, E. Krampl-Bettelheim3, I. Vogel5, H. Larsen6, A. Holmskov7, K. Riis Andreasen8, N. Uldbjerg9, J. Ramb10, B. Bødker11, L. Skibsted12,2, L. Sperling13, S. Hinterberger14, L. Krebs15, H. Zingenberg16, E. Weiss17, I. Strobl18, L. Laursen19, J. Tranberg Christensen20, B. M. Hansen21, A. Lando21, A. Tabor1,2 1Department of Fetal Medicine 4002, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; 2Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark; 3Department of Obstetrics & Gynecology, Medical University of Vienna, Vienna, Austria; 4Harris Birthright Research Centre for Fetal Medicine, King’s College Hospital, London, United Kingdom; 5Department of Clinical Genetics, Aarhus University Hospital Skejby, Aarhus, Denmark; 6Department of Obstetrics & Gynecology, Aalborg Hospital, Aalborg, Denmark; 7Department of Obstetrics & Gynecology, Viborg Hospital, Viborg, Denmark; 8Department of Obstetrics & Gynecology, Hvidovre Hospital, Hvidovre, Denmark; 9Department of Obstetrics & Gynecology, Aarhus University Hospital Skejby, Aarhus, Denmark; 10Department of Obstetrics & Gynecology, Sønderborg Hospital, Sønderborg, Denmark; 11Department of Obstetrics & Gynecology, Hillerød Hospital, Hillerød, Denmark; 12Department of Obstetrics & Gynecology, Roskilde University Hospital, Roskilde, Denmark; 13Department of Obstetrics & Gynecology, Herlev Hospital, Herlev, Denmark; 14Department of Obstetrics & Gynecology, General Hospital of Klagenfurt, Klagenfurt, Austria; 15Department of Obstetrics & Gynecology, Holbæk Hospital, Holbæk, Denmark; 16Department of Obstetrics & Gynecology, Glostrup Hospital, Glostrup, Denmark; 17Department of Obstetrics & Gynecology, Medical University of Graz, Graz, Austria; 18Department of Obstetrics & Gynecology, Medical University of Innsbruck, Innsbruck, Austria; 19Department of Obstetrics & Gynecology, Odense University Hospital, Odense, Denmark; 20Department of Obstetrics & Gynecology, Gentofte Hospital, Gentofte, Denmark; 21Department of Neonatology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark

OC06.01: Vaginal progesterone and the risk of preterm delivery in high‐risk twin gestations ‐ secondary analysis of a placebo‐controlled randomized trial

K. Klein1, L. Rode2,3, K. Nicolaides4, E. Krampl-Bettelheim1, H. Larsen5, A. Holmskov6, K. Riis Andreasen7, N. Uldbjerg8, J. Ramb9, B. Bodker10, L. Skibsted11, L. Sperling12, S. Hinterberger13, L. Krebs14, H. Zingenberg15, E. Weiss16, I. Strobl17, L. Laursen18, J. Tranberg Christensen19, I. Vogel20, B. M. Hansen21, A. Lando21, A. Tabor2,3 1Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria; 2Department of Fetal Medicine 4002, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; 3Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark; 4Harris Birthright Research Centre for Fetal Medicine, King’s College Hospital, London, United Kingdom; 5Department of Obstetrics and Gynecology, Aalborg Hospital, Aalborg, Denmark; 6Department of Obstetrics and Gynecology, Viborg Hospital, Viborg, Denmark; 7Department of Obstetrics and Gynecology, Hvidovre Hospital, Hvidovre, Denmark; 8Department of Obstetrics and Gynecology, Aarhus University Hospital Skejby, Aarhus, Denmark; 9Department of Obstetrics and Gynecology, Sonderborg Hospital, Sonderborg, Denmark; 10Department of Obstetrics and Gynecology, Hillerod Hospital, Hillerod, Denmark; 11Department of Obstetrics and Gynecology, Roskilde University Hospital, Roskilde, Denmark; 12Department of Obstetrics and Gynecology, Herlev Hospital, Herlev, Denmark; 13Department of Obstetrics and Gynecology, General Hospital of Klagenfurt, Klagenfurt, Austria; 14Department of Obstetrics and Gynecology, Holbaek Hospital, Holbaek, Denmark; 15Department of Obstetrics and Gynecology, Glostrup Hospital, Glostrup, Denmark; 16Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria; 17Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria; 18Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark; 19Department of Obstetrics and Gynecology, Gentofte Hospital, Gentofte, Denmark; 20Department of Clinical Genetics, Aarhus University Hospital Skejby, Aarhus, Denmark; 21Department of Neonatology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark