Lone Laursen

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

To assess outcome in twin pregnancies according to chorionicity.

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

Catamenial pneumothorax treated by laparoscopic tubal occlusion using Filshie clips

From November 1998 to June 1999 a previously healthy 38-year-old woman experienced seven episodes of recurrent spontaneous right-sided pneumothorax associated with the period of menstruation. The intervals of menstruation were regular and she described neither gynecologic complaints nor pelvic pain. Her obstetric history was three vaginal deliveries and apart from these no hospitalization. There was no history of thoracic disease, and she was a nonsmoker. The woman was each time admitted to hospital because of right-sided chest pain and dyspnoea. Physical and radiological examination confirmed each diagnosis of pneumothorax. Twice she was treated with chest drainage. Thorascopy diagnosed an area apically of different sized blebs/bullae located on the surface of the parietal pleura (subpleural) and thin adhesions from the lung to the parietal pleura. The pulmonary parenchyma appeared normal and in particular no bullae were seen. Pleural abrasion was performed eliminating the pleural blebs. With her next menstruation the woman presented with a pneumothorax located at the basal part of her right lung indicating sufficient efficacy of the apical pleurodesis. Computed tomography revealed no further pathology apart from the pneumothorax and pneumomediastinum. Chemical pleurodesis with administration of tetracycline was done to prevent recurrent basal pneumothorax. The symptoms of catamenial pneumothorax were now commanding and suspecting thoracic endometriosis a laparoscopy was performed and tubal occlusion planned. At laparoscopy the left ovary had several purplish-red nodules owing to endometriosis of the ovary and along the sacrouterine ligaments tiny bullae and minor chronic inflammation of the peritoneum were noted consistent with the diagnosis of pelvic endometriosis. The diaphragmatic surface was normal with no abnormalities or fenestrations to be seen. The histological evaluation revealed hemorrhagic foci but no exact diagnosis of endometriosis could be stated. Cytological examination of the pleural fluid offered no diagnosis either. Tubal occlusion using Filshie clips was carried out. The woman has had no recurrent pneumothorax. Discussion

Long‐term effects of prenatal progesterone exposure: neurophysiological development and hospital admissions in twins up to 8 years of age

To perform a neurophysiological follow‐up at 48 or 60 months of age in children exposed prenatally to progesterone compared with a placebo and evaluate their medical histories up to 8 years of age.

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.

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

Long-term effects of prenatal progesterone exposure: neurophysiological development and hospital admissions in twins up to 8 years of age: Prenatal progesterone exposure and outcome in twins

To perform a neurophysiological follow‐up at 48 or 60 months of age in children exposed prenatally to progesterone compared with a placebo and evaluate their medical histories up to 8 years of age.

Long-term effects of prenatal progesterone exposure: neurophysiological development and hospital admissions in twins up to 8 years of ageneurophysiological development and hospital admissionsin twins up to 8 years of age

To perform a neurophysiological follow‐up at 48 or 60 months of age in children exposed prenatally to progesterone compared with a placebo and evaluate their medical histories up to 8 years of age.

OC22.03: The association between fetal gender combination in twin pregnancies and gestational age at delivery

Objective: To compare maternal and fetal outcome in dichorionic spontaneous, fertility therapy-derived, reduced twin pregnancies and in triplet gestations managed in two tertiary care centres. Methods: Patients with twin and triplet pregnancies managed in the period January 1988 – December 2008 were included, and divided in four groups: spontaneous dichorionic twin pregnancies (Group A), twin pregnancies from assisted reproductive technologies (Group B), twin pregnancies from multifetal reduction (Group C) and triplet pregnancies from assisted reproductive technologies (Group D). All pregnancies included were viable after 20 weeks. Maternal and fetal outcomes were analysed. Results: The first consecutive 200 patients (414 fetuses) were considered for preliminary results: 135 in Group A, 32 in Group B, 19 in Group C and 14 in Group D. Mean maternal age was 31 ± 5 in the whole series, and not significantly different in the four groups. Nulliparity was significantly lower in group A (65%) than in groups B, C, and D. The prevalence of threatened preterm delivery (39%), preterm premature rupture of membranes (17%), preeclampsia (9%), PIH (6%), gestational diabetes (5%), and cholestasis (3%) was not significantly different in the four groups. The prevalence of malformations (3%), fetal deaths (2%) and perinatal mortality (6%) was not significantly different in the four groups. The prevalence of Apgar score at 5′ < 7 was significantly lower in group D (33%) than in group A (13%). Gestational age at delivery was significantly different between Group D and A. Birthweight and weight-discordancy > 20% were significantly different between Group D and A, B and C. Conclusions: Maternal and fetal outcome of fertility therapy-derived and reduced twin pregnancies was similar to that in dichorionic spontaneous twin gestations. Triplets had a higher risk of low birth weight and weight-discordancy > 20%, but maternal and other fetal outcomes were not significantly different.