Harald Almström

Comparison of umbilical-artery velocimetry and cardiotocography for surveillance of small-for-gestational-age fetuses

Intrauterine growth retardation is associated with an increased risk of fetal asphyxia as well as greater perinatal morbidity and mortality. Ultrasound fetometry enables detection of fetuses that are small for gestational age. Doppler velocimetry of the umbilical artery has good predictive ability for fetal distress, but it is not yet clear whether it could replace cardiotocography in antenatal surveillance of small-for-gestational-age fetuses. We have done a randomised comparison of the two methods. At four obstetric departments in Sweden, women with fetuses found to be small on ultrasound examination at 31 completed weeks of pregnancy or later were randomly assigned to antenatal surveillance with either doppler velocimetry (doppler; 214) or cardiotocography (CTG; 212). Pregnancies in the doppler group were managed according to a protocol based on blood-flow classes deriving from the semiquantitative evaluation of umbilical-artery velocity waveforms; unless the pregnancy was complicated by any other disorder, no antenatal cardiotocography was done. By comparison with the CTG group, the doppler group had fewer monitoring occasions (mean 4.1 [SD 3.1] vs 8.2 [6.2], p < 0.01), antenatal hospital admissions (68 [31.3%] vs 97 [45.8%], p < 0.01), inductions of labour (22 [10.3%] vs 46 [21.7%], p < 0.01), emergency caesarean sections for fetal distress (11 [5.1] vs 30 [14.2%], p < 0.01), and admissions to neonatal intensive care (76 [35.5%] vs 92 [43.4%], p = 0.10). The groups did not differ in gestational age at birth, birthweight, Apgar scores, or total number of caesarean deliveries. Umbilical-artery doppler velocimetry of small-for-gestational-age fetuses allows antenatal monitoring and obstetric interventions to be aimed more precisely than does cardiotocography.

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.

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.

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.

Is measurement of nuchal translucency thickness a useful screening tool for heart defects? A study of 16 383 fetuses

To determine the performance of nuchal translucency thickness (NT) measurement as a screening method for congenital heart defects (CHD) among fetuses with normal karyotype.

Screening for Down syndrome based on maternal age or fetal nuchal translucency: a randomized controlled trial in 39,572 pregnancies.

Nuchal translucency (NT) screening increases antenatal detection of Down syndrome (DS) compared to maternal age‐based screening. We wanted to determine if a change in policy for prenatal diagnosis would result in fewer babies born with DS.

By how much does increased nuchal translucency increase the risk of adverse pregnancy outcome in chromosomally normal fetuses? A study of 16 260 fetuses derived from an unselected pregnant population.

In this study we aimed to estimate the magnitude of a possible increase in risk of adverse outcome in fetuses with normal karyotype and increased nuchal translucency (NT), and to determine how well NT measurements can distinguish between fetuses with normal and adverse outcome.

Fetal loss rate after second trimester amniocentesis at different gestational age

BACKGROUND Recent studies have debated the safety of early amniocentesis, one of which reported a significant increase in spontaneous fetal losses following amniocentesis performed at 10-13 weeks of gestation. The aim of this study was to determine the fetal loss rate following amniocentesis performed at different stages in the second trimester. METHODS One thousand six hundred and fifty-one consecutive amniocenteses undertaken in a low risk population between 13 weeks+0 days and 20 weeks+6 days were evaluated. In 87% of the women the reason for testing was maternal age (mean 37.1 years). Data concerning patients, procedure details and pregnancy outcome were recorded. RESULTS Spontaneous abortion before 28 weeks of gestation occurred in 1.1%, one third of which were within two weeks and the remaining within seven weeks after the procedure. The fetal loss rate was higher when the amniocentesis was performed earlier in pregnancy, at 13 weeks+0 days exceeding 3%. Abnormal color of the amniotic fluid and leakage of amniotic fluid were strong predictors of fetal loss. Transplacental needle insertion did not increase the risk of pregnancy loss. CONCLUSION Amniocentesis performed very early in the second trimester is followed by an increased fetal loss rate that cannot be explained solely by a higher risk of spontaneous abortion at this time of gestation.

Serial antenatal monitoring compared with labor induction in post-term pregnancies

Objective. In view of the increased risk of obstetric and perinatal complications in post‐term pregnancy, and the lack of consensus regarding clinical routines for fetal surveillance and labor induction, the aim of this prospective controlled study was to compare obstetric and perinatal outcome after serial monitoring until 43 weeks of gestation with that after labor induction at 42 gestational weeks.

Value of Uterine Artery Doppler in Endometrial Cancer

Twenty-seven women with endometrial cancer were studied with Doppler ultrasound coupled with a vaginal probe. Pulsatility index of the flow velocity of the uterine artery was recorded and compared to that of a control group. The subjects and the controls did not differ in blood flow measurements. There was no correlation between severity of disease and flow velocimetry values. Eleven of the patients underwent brachytherapy prior to surgery. Administration of brachytherapy resulted in a decrease of the peripheral resistance. The results of this study indicate that Doppler velocimetry of the uterine artery is not a valuable tool in discriminating between malignant and benign endometrium.