Lillian Skibsted

Influence of Operations for Stress Incontinence And/Or Genital Descensus on Sexual Life

A variety of operations for stress incontinence or genital descensus are performed in gynecological departments. The purpose of this study was to find out whether these operations influenced the patients’ sexual life. In a prospective study of 55 women, all sexually active prior to the operation, various characteristics were evaluated by interview and gynaecological examination, immediately before and 6 months after the operation. We had adviced early resumption of sexual intercourse. Postoperatively, 13 of 55 (24%) patients experienced improvement in their sexual life, 37 of 55 (67%) no change, and 5 of 55 (9%) experienced a deterioration. Improvement often resulted from cessation of urinary incontinence. Deterioration was in all 5 cases due to dyspareunia and all 5 patients underwent a posterior colporrhaphy as part of the operation. We conclude that provided the patients are well‐informed the prognosis for sexual life after these operations is good. However, colpoperineoplasty in combination with anterior colporrhaphy might cause dyspareunia in some patients.

Acardiac twins: pathophysiology, diagnosis, outcome and treatment. Six cases and review of the literature.

Twin gestation is often a hazardous pregnancy and especially the monochorionic twin pregnancy significantly contributes to fetal morbidity and mortality. Among the serious complications with twins, the twin-twin transfusion syndrome complicates 5–35% of monozygotic twin pregnancies with monochorionic placentation. Acardiac twinning, earlier known as chorioangiopagus parasiticus, is the most extreme manifestation of this condition. An acardiac twin is a rare complication of multifetal pregnancy, in the literature reported at an incidence of 1% of monochorionic twin pregnancies, i.e. 1 of 35,000 pregnancies. In the following paper we review the literature on the subject and report 6 cases, 5 twins and 1 triplet, that were diagnosed at our department during the period of 1993–1997 and treated conservatively. Only 1 child survived.

Influence of chorionicity on perinatal outcome in a large cohort of Danish twin pregnancies.

To assess outcome in twin pregnancies according to chorionicity.

First-trimester screening for trisomy 21 in Denmark: implications for detection and birth rates of trisomy 18 and trisomy 13.

In Denmark a new national guideline for prenatal screening and diagnosis was issued in 2004 according to which all pregnant women should be offered a first‐trimester combined risk assessment for trisomy 21 (T21). The aim of this study was to investigate whether the new screening strategy for T21 has changed the gestational age at which trisomy 18 (T18) and trisomy 13 (T13) are diagnosed prenatally, and the number of infants born with T18 or T13.

Twin births: cesarean section or vaginal delivery?

Objective. To assess morbidity and mortality in twin pregnancy deliveries, according to chorionicity and mode of delivery. Design. Population‐based retrospective cohort. Setting. Fourteen obstetric departments in Denmark. Population. One thousand one hundred and seventy‐five twin pregnancies with two live fetuses at 36+0 weeks of gestation. Methods. Pregnancy outcomes assessed according to chorionicity and mode of delivery. Main outcome measures. Poor outcome defined as five min Apgar score ≤ 7, umbilical artery pH < 7.10, admission to neonatal unit for more than three days or death. Results. Dichorionic (DC) twins, delivered after 36 gestational weeks, with intended vaginal delivery (n= 689) compared with DC twins with planned cesarean section (n= 371) had an increased risk of poor outcome [odds ratio (OR) 1.47, p= 0.037] after adjustment for body mass index, parity and weight discordance. There was no increased risk for poor outcome in monochorionic (MC) twins with intended vaginal delivery (n= 63) compared with planned cesarean section (n= 52; OR 0.87, 95% confidence interval 0.26–2.96). Nulliparity increased the risk of poor outcome in DC (OR 1.5, p= 0.03) and in MC twins (OR 4.01, p= 0.02), as well as birthweight discordance >300 g (DC, OR 1.50, p= 0.02; and MC, OR 6.02, p= 0.002). For DC twins, we found a significantly higher risk of poor outcome of the second‐born twin compared with the first (OR 1.64, p= 0.001). Conclusions. Dichorionic twins born after 36 weeks of gestation had a higher risk of poor outcome by intended vaginal delivery than by planned cesarean section. For MC twins, statistical differences in outcome by mode of delivery could not be seen.

The Danish Fetal Medicine Database: establishment, organization and quality assessment of the first trimester screening program for trisomy 21 in Denmark 2008–2012

To describe the establishment and organization of the Danish Fetal Medicine Database and to report national results of first‐trimester combined screening for trisomy 21 in the 5‐year period 2008–2012.

Prenatal detection of congenital heart disease in a low risk population undergoing first and second trimester screening

The prenatal detection rate of congenital heart disease (CHD) is low compared with other fetal malformations. Our aim was to evaluate the prenatal detection of CHD in Eastern Denmark.

Acardiac Twin with Preserved Brain

The fatal acardiac syndrome is a rare complication of monochorionic twinning and is reported in 1 of 35,000 births. It is caused by arterioarterial and venovenous placental anastomoses leading to circulatory predominance of 1 twin. The donor ‘pump’ twin provides circulation for itself and for the recipient acardiac twin. The acardiac twin is usually grossly abnormal with severe reduction anomalies of the upper part of the body. We report a twin pregnancy, where a recipient twin initially by ultrasound was misdiagnosed as dead. In the third trimester the supposedly dead twin presented as an edematous acardiac twin without peripheral reduction defects and a nearly normally developed brain. An acardiac twin with a nearly normal external appearance and an almost normally developed brain, nourished by a surviving twin brother, has not previously been described in the literature.

Fetal Cor Triatriatum Dexter: A Report of Two Cases Associated with Nuchal Edema in Early Second Trimester

Two early-2nd-trimester fetuses were aborted as a result of nuchal edema and suspected severe heart malformation. At autopsy one fetus demonstrated nuchal edema, mild hydronephrosis, and cor triatriatum dexter associated with ventricular septal defect and tubular hypoplasia of the aortic arch. The other fetus demonstrated severe nuchal edema, and cor triatriatum dexter was the only malformation. Cor triatriatum dexter is a rare cardiac malformation characterized by division of the right atrium into 2 compartments by a usually fenestrated membrane representing remnants of the right valve of the embryonic sinus venosus. This malformation has been diagnosed in adults and children by echocardiography, surgery, or autopsy but has not previously been published in fetuses.

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