Lone Krebs

Elective cesarean delivery for term breech.

OBJECTIVE To compare the maternal complications of elective cesarean delivery for breech at term with those after vaginal or emergency cesarean delivery. METHODS We conducted a population-based, retrospective cohort study of 15,441 primiparas who delivered singleton breech at term. Information was obtained from the Danish Medical Birth Register, the Register of Death Causes, and the Denmark Patient Register. RESULTS Elective cesarean delivery was associated with lower rates of puerperal fever and pelvic infection (relative risk [RR] 0.81; 95% confidence interval [CI] 0.70, 0.92), hemorrhage and anemia (RR 0.91; 95% CI 0.84, 0.97), and operations for wound infection (RR 0.69; 95% CI 0.57, 0.83) than emergency cesarean delivery. There was a higher rate of puerperal fever and pelvic infection (RR 1.20; 95% CI 1.11, 1.25) than for vaginal delivery. Thromboembolic disease occurred in 0.1% of women with cesarean delivery, and anal sphincter rupture occurred in 1.7% of women with vaginal delivery. Elective cesarean delivery was not associated with subsequent ectopic pregnancy, miscarriage, placental complications, uterine rupture, or adverse neonatal outcome. Women with elective cesarean delivery were more often delivered by elective cesarean in their second pregnancy, compared with women delivered vaginally (RR 1.25; 95% CI 1.21, 1.29). Elective cesarean delivery was associated with a lower rate of a subsequent delivery during the study period and a longer mean delivery interval than for vaginal delivery. CONCLUSION Elective cesarean delivery for term breech carries a low risk of severe maternal complications.

First trimester maternal serum PAPP‐A, β‐hCG and ADAM12 in prediction of small‐for‐gestational‐age fetuses

To examine the ability of predicting fetuses being small‐for‐gestational‐age (SGA) at delivery with the maternal serum markers pregnancy‐associated plasma protein A (PAPP‐A), beta‐human chorionic gonadotrophin (β‐hCG) and A disintegrin and metalloprotease 12 (ADAM12) in first trimester.

Consequences of the Term Breech Trial in Denmark

Objective. To analyze the consequences of the handling of breech presentation in Denmark after publication of the Term Breech Trial (TBT). Design. Population‐based retrospective cohort study. Settings. Data from the National Birth Registry and discharge letters from cases with perinatal death. Population. Singleton breech fetuses at term and alive at onset of labor delivered between 1997 and 2008 (n=23 789). Methods. Outcomes before and after publication of TBT were compared and analyzed by planned mode of delivery. Main outcome measures. Cesarean section, intrapartum or early neonatal mortality in infants without lethal congenital malformations, Apgar score ≤6 at five minutes and admittance to neonatal intensive care unit (NICU) for four days or more. Results. The rate of cesarean section increased from 79.6 to 94.2%. Intrapartum or early neonatal mortality was reduced from 0.13 to 0.05%[relative risk (RR) 0.38 (95% confidence intervals (CI) 0.15–0.98)]. The incidence of low Apgar scores declined from 1.0 to 0.6%[RR 0.83 (95%CI 0.73–0.95)] and admission to NICU from 4.2 to 3.2%[RR 0.92 (95%CI 0.87–0.97)]. Planned vaginal delivery was associated with an increased risk of mortality, low Apgar score and admission to NICU throughout the period. Conclusion. Reduction in the rate of vaginal delivery was correlated with a significant reduction in rates of intrapartum or early neonatal mortality and morbidity, but at a much lower level than reported in the Term Breech Trial. The lower rate of vaginal delivery, indicating a strict selection of women, did not reduce the relative risks of complications during a planned vaginal delivery.

The relation of breech presentation at term tocerebral palsy

Objective To examine the relation between breech delivery and cerebral palsy, considering the influence of intrauterine growth, low Apgar score at birth, and mode of delivery.

The Nordic medical birth registers – a potential goldmine for clinical research

The Nordic medical birth registers have long been used for valuable clinical research. Their collection of data for more than four decades offers unusual possibilities for research across generations. At the same time, serum and blotting paper blood samples have been stored from most neonates. Two large cohorts (approximately 100 000 births) in Denmark and Norway have been described by questionnaires, interviews and collection of biological samples (blood, urine and milk teeth), as well as a systematic prospective follow‐up of the offspring. National patient registers provide information on preceding, underlying and present health problems of the parents and their offspring. Researchers may, with permission from the national authorities, obtain access to individualized or anonymized data from the registers and tissue‐banks. These data allow for multivariate analyses but their usefulness depends on knowledge of the specific registers and biological sample banks and on proper validation of the registers.

Abnormally invasive placenta-prevalence, risk factors and antenatal suspicion: results from a large population-based pregnancy cohort study in the Nordic countries.

The objective was to investigate prevalence, estimate risk factors, and antenatal suspicion of abnormally invasive placenta (AIP) associated with laparotomy in women in the Nordic countries.

First trimester maternal serum pregnancy-specific beta-1-glycoprotein (SP1) as a marker of adverse pregnancy outcome.

To establish the first trimester levels of pregnancy‐specific beta‐1‐glycoprotein (SP1) in pregnancies with adverse outcome. Furthermore, to determine the screening performance for adverse outcome using SP1 alone and in combination with other first trimester markers including proMBP and PAPP‐A.

First‐trimester combined screening for Down syndrome: prediction of low birth weight, small for gestational age and pre‐term delivery in a cohort of non‐selected women

To establish the relationship between the first‐trimester screening markers [pregnancy‐associated plasma protein A (PAPP‐A), free human chorionic gonadotrophin‐β (β‐hCG), nuchal translucency (NT)], the Down syndrome (DS) risk estimate, and the adverse outcomes such as low birth weight, small for gestational age (SGA) and pre‐term delivery.

Breech at termmode of delivery

Background. The present study was designed to determine neonatal mortality and morbidity in non‐malformed singleton term infants delivered in breech presentation and identify a possible correlation between outcome on the one hand and mode of delivery, parity and birth weight on the other.

Long-term outcome in term breech infants with low Apgar score—a population-based follow-up

OBJECTIVE To investigate the relation between low Apgar score in breech infants and handicap in childhood. STUDY DESIGN A case-control study. A questionnaire to mothers of 323 non-malformed, singleton infants delivered in breech presentation at term, 105 cases with Apgar score below 7 at 5 min and 218 controls. RESULTS Four cases (4.6%) and one control (0.5%) had cerebral palsy. In infants without cerebral palsy, speech/language problems were more frequent than controls (10.6 versus 3.2%) (P=0.02). There were no differences in rates of deficits in attention, motor control and perception (DAMP), epilepsy, cognitive developmental delay or learning disabilities. Absence of any handicap or disability was reported in 65 cases (75%) compared to 172 controls (92%) (OR: 3.9; 95% CI: 1.9-7.9). CONCLUSION Even though low Apgar score indicates an increased risk of neurological sequelae, most (75%) breech infants with low Apgar score are without a handicap/disability at follow-up.