Sissel Saltvedt

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.

Estimation of blood loss after cesarean section and vaginal delivery has low validity with a tendency to exaggeration

Background. Excessive bleeding is one of the major threats to women at childbirth. The aim of this study was to validate estimation of blood loss during delivery. Methods. Bleeding was estimated after 29 elective cesarean sections and 26 vaginal deliveries and compared to blood loss measured by extraction of hemoglobin using the alkaline hematin method, according to Newton. Results. Inter‐individual agreement of estimation showed good results. Estimated loss in comparison with measured loss resulted in an over‐estimation. In vaginally delivered women, there was no correlation between estimated and measured blood loss (r2 = 0.13), and in women delivered by elective cesarean section, the correlation was moderate (r2 = 0.55). Agreement, according to Bland and Altman, indicated that measured blood loss could vary from 570 ml less to 342 ml more than estimated blood loss. Conclusions. The standard procedure of estimation of obstetric bleeding was found to be unreliable. In this study, blood loss was over‐estimated in cesareans. In vaginal deliveries, there seemed to be no correlation. Estimated blood loss as a quality indicator or as a variable in studies comparing complications must be used with caution. For clinical purposes, estimation of blood loss and measurement of post partum hemoglobin is of low value and may lead to the wrong conclusions.

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.

Does fetal screening affect women's worries about the health of their baby? : a randomized controlled trial of ultrasound screening for Down's syndrome versus routine ultrasound screening

Background.  Screening for fetal abnormality may increase womens anxiety as attention is directed at the possibility of something being wrong with the baby. The aim of this study was to evaluate the effect of ultrasound screening for Downs syndrome on womens anxiety in mid‐pregnancy and 2 months after delivery.

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.

Asthma during pregnancy in a population-based study--pregnancy complications and adverse perinatal outcomes.

Background Asthma is one of the most common chronic diseases, and prevalence, severity and medication may have an effect on pregnancy. We examined maternal asthma, asthma severity and control in relation to pregnancy complications, labour characteristics and perinatal outcomes. Methods We retrieved data on all singleton births from July 1, 2006 to December 31, 2009, and prescribed drugs and physician-diagnosed asthma on the same women from multiple Swedish registers. The associations were estimated with logistic regression. Results In total, 266 045 women gave birth to 284 214 singletons during the study period. Maternal asthma was noted in 26 586 (9.4%) pregnancies. There was an association between maternal asthma and increased risks of pregnancy complications including preeclampsia or eclampsia (adjusted OR 1.15; 95% CI 1.06–1.24) and premature contractions (adj OR 1.52; 95% CI 1.29–1.80). There was also a significant association between maternal asthma and emergency caesarean section (adj OR 1.29; 95% CI 1.23–1.34), low birth weight, and small for gestational age (adj OR 1.23; 95% CI 1.13–1.33). The risk of adverse outcomes such as low birth weight increased with increasing asthma severity. For women with uncontrolled compared to those with controlled asthma the results for adverse outcomes were inconsistent displaying both increased and decreased OR for some outcomes. Conclusion Maternal asthma is associated with a number of serious pregnancy complications and adverse perinatal outcomes. Some complications are even more likely with increased asthma severity. With greater awareness and proper management, outcomes would most likely improve.

Epidemiology of Retained Placenta Oxytocin as an Independent Risk Factor

OBJECTIVE: To identify factors related to retained placenta in the context of contemporary obstetric practice. METHODS: This was a case-control study comparing 408 cases of retained placenta and an equivalent number of control individuals. Epidemiological and delivery-related variables were registered in computerized prenatal and in-hospital medical records. Univariable and multivariable logistic regressions were used for estimation of risk ratios and statistical significance. RESULTS: Independent risk factors for retained placenta were: previous retained placenta (odds ratio [OR] 12.61, 95% confidence interval [CI] 3.61–44.08); preterm delivery (OR 3.28, 95% CI 1.60–6.70); oxytocin use for 195–415 minutes (OR 2.00, 95% CI 1.20–3.34); oxytocin use more than 415 minutes (OR 6.55, 95% CI 3.42–12.54, number needed to harm 2.3); preeclampsia (OR 2.85, 95% CI 1.20–6.78); two or more previous miscarriages (OR 2.62, 95% CI 1.31–5.20); and one or more previous abortion (OR 1.58, 95% CI 1.09–2.28). Parity of two or more had a seemingly protective effect (OR 0.40, 95% CI 0.24–0.70), as did smoking at the start of pregnancy (OR 0.28, 95% CI 0.09–0.88). Retained placenta was significantly associated with an increased risk of postpartum hemorrhage. The OR related to blood loss exceeding 500 mL, 1,000 mL, and 2,000 mL and the need for blood transfusion was 33.07 (95% CI 20.57–53.16), 43.44 (95% CI 26.57–71.02), 111.24 (95% CI 27.26–454.00), and 37.48 (95% CI 13.63–103.03), respectively. Diabetes was numerically overrepresented in the case group, but the power of the study to detect a significant difference in risk outcome was insufficient. CONCLUSION: Identifying risk factors for retained placenta is important in the assessment of women after delivery. The increased risk associated with duration of oxytocin use is of interest, considering its widespread use. LEVEL OF EVIDENCE: II

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.